LEUCORRHCEA 


AND    OTHER   VARIETIES    OF 
GYNECOLOGICAL  CATARRH 


A    TREATISE    ON    THE    CATARRHAIv    AFFECTIONS     OE     THE 

GENITAI,  CANAI.  OE  WOMEN  ;   THEIR  MEDICAI.  AND 

SURGICAI,   TREATMENT. 


BY 

HOMER  IRVIN  OSTROM,  M.  D. 

NEW   YORK 

Surgeon    to   the   Metropolitan  Hospital 
Surgeon  to  the  Hahnemann  Hospital 

Senior  Member  of  the  American  Institute  of  Homoeopathy;  Member 
of  the  New  York  State  Homoeopathic  society;    Homoeopathic 
Medical  Society  of  the  County  of  New  York;  Member  of  the 
Academy  of  Pathological  Science;  American  Obstetri- 
cal Society;  Surgical  and  Gynaecological  Associa- 
tion; Fellow  of  the  Medico  Chirurgical  so- 
ciety; Fellow  of  the  British   Gyneco- 
logical Society. 


AUTHOR  OF 

A  Treatise  on  the  Breast  and  Its  Surgical  Diseases 

Epitheliofna  of  the  Mouth 

The  Diseases  of  the  Uterine  Cervix 


PHILADELPHIA,   PA.: 

BOERICKE  &  TAFEL 

1910 


COPYRIGHTED    BY 

BOERICKE  &  TAFEL 

1910 


PREFACE. 

Many  of  the  minor  diseases  peculiar  to 
women  are  associated  with  disorders  of  the 
mucous  membrane  that  lines  the  genital 
canal,  but  we  are  rather  inclined  to  disre- 
gard these  affections  in  favor  of  operative 
gynaecology,  and  for  the  development  of  sur- 
gical technique.  This  class  of  disease,  how- 
ever, merits  careful  consideration,  not  only 
because  of  its  primary  importance,  but  on  ac- 
count of  its  significance  as  an  etiological 
factor  in  more  serious  maladies. 

The  commonly  used  term,  leucorrhoea,  sig- 
nifies only  one  form  of  catarrh— a  milk}^ 
white  flow — and  is,  therefore,  not  compre- 
hensive enough  to  embrace  every  variety  of 
mucous  discharge,  while  catarrh,  used  in  the 
same  sense  as  when  applied  to  other  mucous 
membranes,  conveys  a  more  accurate  under- 
standing of  the  pathology  and  clinical  his- 
tory of  the  gynaecic  mucous  membrane  dis- 
ease. 

Specific  catarrh  is  not  included,  for  the 
reason  that  it  constitutes  a  special  class  of 
disease,  that  requires  special  treatment. 


IV  PRE^FACi:. 

The  classification  of  gynaecological  ca- 
tarrh here  adopted  is  based  upon  the  char- 
acter of  the  discharge.  Such  a  grouping  is 
not  entirely  satisfactory,  but  the  anatomical 
divisions  of  the  genital  canal,  which  in  health 
are  clearly  defined,  become  blurred  in  dis- 
ease, and  in  consequence  cannot  be  relied 
upon  for  classification;  and,  moreover,  no 
form  of  gynaecological  catarrh  belongs  to 
any  one  period  of  life,  and,  therefore,  the 
clinical  history  alone  cannot  be  relied  upon 
for  this  purpose. 

Part  IV.,  dealing  with  Therapeutic  Sug- 
gestions, includes  a  repertory,  and  is,  as  its 
name  implies,  merely  suggestive.  No  at- 
tempt is  made  to  record  more  than  the  actual 
symptoms  of  catarrh,  with  a  few  concomi- 
tants and  generalizations.  Because  of  the 
lack  of  exactness  in  recording  symptoms,  it 
has  in  some  instances  been  found  difficult  to 
distinguish  catarrh  from  the  discharge  of  a 
malignant  disease,  or  neoplasm,  but  such 
conditions  have  been  eliminated  as  much  as 
possible. 

130  West  ^yth  Street, 

New  York  City. 

November,  ipio. 


CONTENTS. 


Preface 


V 


Chapter  I, 

Anatomy  of  the  genital   canal    i 

Physiology  of  the  parts  especially  involved  in  catarrh  13 

Function  of  the  mucous  membrane  16 

Chapter  II. 

The  nature  of  catarrh  in  general   18 

The  causes  of  gynaecological  catarrh   20 

Infection     21 

Constitution    22 

Mechanics      23 

Exanthematous   diseases    24 

Chapter  III. 

Classification  of  Gynaecological  Catarrh  zy 

Simple   catarrh    28 

Infants   and   children    30 

Treatment,    local    31 

Adults    36 

Treatment,    local    , 2)1 

medical    42 

Young    girls     43 

Mucopurulent   catarrh    (leucorrhoea)    44 

Adults,    children     46 

Treatment,    local    57 

constitutional     62 

medical     6S 


VI  CONTENTS. 

Purulent    catarrh     7j 

Senile    purulent    catarrh    76 

Treatment,    local    So 

operative     82 

curettage     8S 

trachelorrhaphy     90 

constitutional     03 

medical    94 

Sanguineous    catarrh    94 

Treatment,    medical    99 

Senile    catarrh    loi 

Treatment     loi 

Chapter  IV.     Part  I.     Suggestive  therapeutics   105 

Part  II.     Repertory   145 

Index     20^ 


LEUCORRHOEA. 


CHAPTER  I. 

ANATOMY    01^    THK    GENITAI,    CANAI, PHYSI- 

OIvOGY    OF    TPIi:    PARTS    i:SPi:CIAI,IvY    IN- 
VOLVED     IN      CATARRH — FUNCTION 
OF   THE    MUCOUS    MEMBRANE. 

The  genital  canal,  the  part  immediately  in- 
volved in  gynaecological  catarrh,  is  in  the 
form  of  two  opposing  angles,  the  vertical 
line  of  union  extending  from  the  vulva  to  the 
fundus  of  the  uterus,  the  horizontal  lines  to 
the  fimbriated  openings  of  the  Fallopian 
tubes.  These  passages  are  lined  throughout 
with  mucous  membrane,  the  epithelium  and 
construction  of  which  are  variously  modified 
to  meet  physiological  uses. 

The  anatomical  divisions  of  the  canal, 
with  which  gynaecological  catarrh  is  con- 
cerned, are,  from  without  inwards,  the 
vulva,  the  vagina,  the  portio- vaginalis,  the  os 
uteri,  the  cervix  uteri,  and  the  Fallopian 
tubes. 


2  I^KUCORRHC^A. 

The  frame-work  of  the  uro-genital  sys- 
tem, of  which  the  genital  canal  is  a  part,  is 
developed  from  the  embryonal  glands — the 
Mullerian  ducts.  These  organs,  two  in  nurfi- 
ber,  by  fusing,  the  process  begins  in  the 
third  month,  and  the  septum  thus  made  is 
not  completely  removed  until  late  in  the 
eighth  month,  form  the  uterus  and  vagina, 
the  Fallopian  tubes  representing  the  por- 
tions of  the  Mullerian  ducts  that  remain  in- 
tact. 

The  Mullerian  ducts  are  developed  in  the 
mesoblast,  the  middle  or  intermediate  layer 
of  the  blastoderm,  from  which  they  derive 
their  connective  tissue  and  muscular  super- 
structure, but  by  a  process  of  invagination 
of  the  hypoblastic  layer  of  the  coelum  they 
receive  a  covering  of  mesothelial  cells  which 
ultimately  furnishes  the  entire  genital  canal 
with  a  mucous  membrane. 

Beyond  the  fact  that  in  some  parts,  not- 
ably the  corpus  uteri,  where  the  arrange- 
ment of  lining  membrane  is  unlike  that  of 
any  other  mucous  membrane,  for  here  the 
glandular  layer  is  directly  adherent  to  the 
subjacent  muscular  is,  and  there  is  an  absence 


GOBLKT   CE:i,I,S.  3 

of  any  intervening  connective  tissue  sub- 
tratum  or  submucosa,  the  mucous  membrane 
of  the  genital  canal  does  not  differ  materially 
from  mucous  membranes  generally. 

This  tissue,  the  use  of  which  is  to  furnish 
a  protective  covering  for  internal  parts  that 
communicate  with  the  surface  of  the  body — 
an  internal  skin — is  built  upon  a  simple  plan, 
epithelial  cells  and  a  supporting  structure, 
with  epithelial  invaginations  that  form 
glands  having  a  simple,  rarely  a  racemose 
arrangement.  These  glands  are  irregularly 
distributed,  but  while  they  secrete  mucus 
they  cannot  be  regarded  as  an  essential  part 
of  mucous  membrane  architecture;  for  the 
function  of  mucous  elaboration  is  also  per- 
formed by  the  epithelial  cells — goblet  cells — 
which  characteristic  distinguishes  them  from 
all  other  cell  bodies. 

The  supporting  structure  or  corium  is 
composed  of  connective  tissue  intermingled 
with  lymphoid  tissue.  Between  this  and  the 
epithelium  is  usually  found  a  basement  mem- 
brane composed  of  flattened  cells  which  fol- 
low all  the  inequalities  of  the  mucous  mem- 
brane, where  it  aids  in  the  formation  of  the 


4    .  I^DUCORRHC^A. 

gland  walls.  Beneath  this  is  a  layer  of  thin 
non-striated  muscular  tissue,  which  forms 
the  deepest  part  of  the  mucous  membrane. 
This,  however,  is  not  always  present. 

Mucous  membranes  are  always  abundant- 
ly supplied  with  blood  vessels.  The  arteries 
and  veins  divide  in  the  submucous  tissue, 
sending  a  network  of  capillaries  to  the 
corium,  where  they  lie  immediately  below 
the  epithelial  layer. 

The  glands  with  which  the  genital  mucosa 
is  liberally  supplied,  are  irregular  in  distribu- 
tion and  arrangement,  some  parts  of  the 
canal,  for  example  the  portio-vaginalis,  be- 
ing wholly  devoid  of  them.  The  simple  folli- 
cles are  lined  with  the  same  variety  of  epi- 
thelium that  invests  the  mucous  membrane 
in  which  they  are  situated,  and  open  perpen- 
dicularly to  the  surface  upon  which  they 
pour  their  peculiar  secretion.  When  present 
at  all  they  are  very  numerous,  as  in  the  upper 
two-thirds  of  the  cervical  canal,  where  it  is 
estimated  there  may  be  at  least  ten  thousand 
of  these  minute  bodies. 

No  glandular  structures  exist  in  the 
corpus  uteri  at  birth,  these  formations  are 


i:pithi:i,iai:,  ce:i.i,s.  5 

entirely  post-embryonic.  Nor  do  they  ap- 
pear as  more  than  fissures  made  of  the  folds 
of  the  mucous  membrane  before  the  general 
change  that  ushers  in  puberty;  when  coinci- 
dent with  that  organic  evolution  the  fissures 
assume  a  glandular  form  and  develop  in 
great  numbers,  a  process  that  is  repeated  and 
passed  through  with  each  subsequent  men- 
struation and  pregnancy. 

On  the  basement  membrane  rests  a  layer 
of  epithelium.  Its  cells,  which  are  derived 
from  the  hypoblast  of  the  blastoderm,  are  to 
be  looked  upon  as  the  essential  part  of  all 
mucous  membranes.  Like  other  epithelial 
cells  they  are  transitory,  and  only  assume 
their  characteristic  form  subsequent  to  evo- 
lution. 

Not  all  the  cells  that  make  up  the  epithelial 
covering  of  the  mucosa  are  mucous  forming 
bodies.  Squamous  cells  which  appear  more 
abundant  in  the  region  of  external  openings 
do  not  assume  this  function,  but  in  these 
parts  mucous  glands  are  more  numerous, 
and  the  protective  material  is  supplied  in 
sufficient  quantity  by  them. 

The  epithelial  covering  of  mucous  mem- 


6  i,i:ucorrhce:a. 

brane  is  highly  permeable,  especially  where 
squamous  epithelium  predominates.  In 
these  situations  lymphoid  tissue  is  more 
abundant,  and  lymphoid  elements  in  the  form 
of  mucous  corpuscles  escape  from  the  reticu- 
lar structures. 

The  epithelial  cells  of  the  genital  canal 
vary  in  type  according  to  location,  but  under 
the  demand  of  physiological  requirements,  or 
pathological  irritation,  one  form  may  assume 
any  other  form,  and  so  obliterate  normal 
structural  boundaries.  There  are  no  well  at- 
tested exceptions  to  the  teaching  that  "cells 
breed  true,"  but  this  law  applies  to  the  two 
great  anatomical  divisions,  epithelial,  and 
connective  tissue — epiblastic  and  meso- 
blastic.  An  epithelial  cell  may  change  its 
form,  indeed  one  of  its  chief  offices  is  to 
harmonize  in  this  respect  with  local  require- 
ments, but  that  which  distinguishes  an  epi- 
thelial cell  from  a  connective  tissue  cell  con- 
tinues with  the  integrity  of  the  cell  body. 

Beginning  at  the  border  of  the  labia  major, 
the  mucous  membrane,  which  is  here  contin- 
uous with  the  skin  but  separated  from  it  by  a 
well  marked  line  of  structural  differences. 


VAGINAI,  MUCOUS  MEMBRANE:.  7 

passes  over  the  nymphse  and  clitoris  to  be 
prolonged  into  the  vagina  and  urethra.  Up 
to  the  hymen,  or  its  remains,  the  membrane 
is  covered  with  scaly  epithelium  derived 
from  the  hypoblast,  and  liberally  provided 
with  mucous  crypts  and  follicles,  and  with 
glands  that  secrete  an  unctuous  substance. 
Sebaceous  glands  are  especially  numerous 
beneath  the  prepuce,  upon  the  labia  major 
and  outer  surface  of  the  nymphae.  But  few, 
if  any,  mucous  cells  exist  normally  in  this 
part  of  the  genital  canal,  and,  therefore,  the 
substance  with  which  the  surfaces  are  bath- 
ed is  derived  chiefly  from  the  glands,  and 
lymphoid  structures. 

The  vagina,  extending  from  the  hymen,  or 
urogenital  diaphragm,  to  the  ring  in  which 
the  portio-vaginalis  of  the  uterus  rests,  is 
lined  with  many  layers  of  squamous  epi- 
thelium derived  from  the  epiblast.  The 
mucous  membrane  being  more  ample  than 
the  underneath  submucosa,  is  thrown  into 
columns  and  rugae.  Mucous  glands  are  few 
in  number,  save  in  the  smoother  portions  of 
the  canal,  the  upper  third  of  the  vagina. 
They,  together  with  mucous  cells,  bathe  the 


8  i,Kucorrhce:a. 

vaginal  walls  in  an  acid  secretion,  but  the 
vaginal  mucosa  is  otherwise  structurally 
quite  homologous  to  the  skin. 

The  mucous  membrane  is  continued  over 
the  portio-vaginalis,  which  comprises  all 
structures  between  the  os  externum  and  the 
vaginal  fornices,  or  ring.  It  is  covered  with 
squamous  epithelium,  the  cells  of  which  se- 
crete an  abundant  acid  mucus.  The  secre- 
tion of  the  portio,  however,  is  not  a  true 
glandular  product,  as  there  are  no  glands  in 
this  region ;  it  results  from  the  delequescence 
and  shedding  of  the  superficial  epithelial 
cells,  and  the  process  by  which  the  goblet 
cells  give  up  their  contents  probably  without 
destruction  of  their  wall. 

The  stratified  epithelial  layer  of  the 
vagina  is  continued  with  more  or  less  dis- 
tinctness beyond  the  external  os  into  the  cer- 
vical canal,  the  lower  third  of  which  it  lines. 
The  upper  two-thirds  are  lined  throughout 
with  a  single  layer  of  epithelial  cells  of  cylin- 
drical type,  the  surface  of  the  membranes  be- 
ing studded  throughout  with  the  minute  ori- 
fices of  numerous  glands.  These,  for  the 
most  part,  simple  follicles,  secrete  a  thick, 


AI,KAI,INK  SI:CRI:TI0N.  9 

viscid  alkaline  mucus.  Non-ciliated  epithe- 
lium lines  the  follicles,  the  cylindrical  cells  of 
which  undergo  the  mucous  or  calyciform 
change  which  belongs  to  the  elaboration  of 
their  peculiar  secretion.  The  characteristic 
''goblet  cells"  are  fairly  numerous  in  the 
membrane  covering  this  part  of  the  cervical 
canal. 

The  interior  of  the  corpus  uteri  is  covered 
with  a  single  layer  of  columnar  cells.     The 

underneath  membrane  is  much  thicker  than 

« 

the  cervical  membrane,  its  maximum  thick- 
ness being  found  at  about  the  middle  of  the 
cavity.  Its  surface  is  studded  with  an  im- 
mense number  of  minute  depressions,  the 
openings  of  small  tubular  glands.  These 
glands  also  elaborate  an  alkaline  fluid,  but  it 
is  devoid  of  the  viscid  properties  of  the  cer- 
vical secretion.  The  epithelial  cells  differ 
from  those  lining  the  glands  of  the  cervix,  in 
that  none  of  them  present  calyciform  char- 
acters. 

A  very  marked  difference  exists  between 
the  time  at  which  the  glands  of  the  corpus 
and  cervix  appear.  At  the  beginning  of  the 
ninth  month  of  gestation  the  epithelium  of 


10  *        i,i:ucorrhce:a. 

the  cervix  begins  to  undergo  mucous  trans- 
formation, indicative  of  secreting  activity. 
Numerous  follicles  also  appear,  and  as  a  re- 
sult of  activity  the  canal  at  birth  is  filled 
with  a  mucous  plug,  which  effectually  closes 
the  interior  of  the  uterus. 

Quite  different  is  the  history  of  the  glands 
of  the  corpus,  for,  w^hile  in  the  sixth  month 
there  are  found  traces  of  tubular  involutions 
of  the  cylindrical  cell  lining  membrane, 
which  later  developes  into  glandular  struct- 
ures, no  true  functionating  glands  are  found 
in  the  corpus  at  birth,  these  organs,  as  before 
stated,  being  post-embryonic. 

As  puberty  advances  the  development  of 
glandular  structures  and  of  the  calyciform 
epithelial  cells  progresses  rapidly,  and  is  re- 
stimulated  at  each  menstruation,  and  gesta- 
tion, but  at  the  climacteric  obsolescence  the 
process  of  secretion,  both  from  glands  and 
the  mucous  epithelial,  begins  to  recede  gradu- 
ally. The  endometrium  is  changed,  its  cellu- 
lar elements  disappear,  and  the  activity  that 
marked  reproductive  life  is  folded  up  and 
ceases. 

The  behavior  of  the  epithelial  cells  that 


MUCOSA  OF  UTERUS.  11 

line  the  utricular  glands  is  of  especial  inter- 
est in  connection  with  the  gynaecological  ca- 
tarrh of  senility.  These  glands  should  in 
health  wholly  disappear,  and  their  function 
terminate  with  the  completion  of  the  meno- 
pause, but  occasionally,  under  not  always  de- 
terminable systemic  and  local  conditions, 
they  degenerate  and  become  pathological 
factors  of  moment  to  the  clinician. 

The  particulars  in  which  the  mucous  mem- 
brane lining  the  body  of  the  uterus  differs 
from  all  other  mucous  coverings  have  gh  en 
rise  to  doubts  as  to  whether  this  should  be 
classed  among  mucous  membranes.  As, 
however,  the  epithelial  cells  do  assume  caly- 
ciform  characteristics,  and  the  glands  secrete 
mucus,  the  name  does  not  seem  to  be  misap- 
plied, even  though  there  is  an  absence  of  sub- 
mucous tissues,  and  the  glands  are  directly 
adherent  to  the  subjacent  muscular  is.  Pos- 
sibly it  would  be  more  accurate  anatomically 
to  consider  this  structure  as  lymphatic  tissue, 
and  its  glands  as  pseudo-glands,  as  merely 
pits  honey-combing  the  epithelial  layer,  but 
its  function  is  that  of  a  mucous  membrane, 
and  unnecessary  confusion  would  follow  a 
change  of  name. 


12  i.e:ucorrhcea. 

Perhaps  more  than  any  other  epitheHal 
cells  those  of  the  genital  canal  show  a  re- 
markable power  of  repair  after  remo\'al  or 
injury.  Curetting  and  operations  on  ihe 
vagina  and  cervix  are  followed  by  very  rapid 
regeneration  of  epithelium. 

The  mucous  membrane  lining  the  Fallo- 
pian tubes  consists  of  columnar  epithelium, 
connective  tissue,  and  musculature.  It  is 
continuous  with  that  of  the  uterus,  but  ac- 
quires a  submucous  layer  at  the  beginning  of 
the  isthmus.  The  membrane  is  thrown  into 
longitudinal  folds  which  become  more 
numerous  in  the  direction  of  the  ampulla. 
True  glands  do  not  exist  in  the  mucous  mem- 
brane of  the  Fallopian  tubes.  There  is  a 
honey-comb  arrangement  of  the  tubal  epi- 
thelium, similar  to  that  found  in  the  uterus, 
but  these  are  no  more  than  depressions  that 
impinge  upon  the  submucous  tissue.  At  the 
border  of  the  fimbria  exists  the  demarcation 
between  the  mucous  membrane  and  the 
serous  structure  of  the  peritoneum.  This 
point  marks  the  anatomical  limit  of  the  ca- 
tarrhal diseases  of  the  female  genital  canal. 
The  physiology  of  the  mucous  membrane  of 


gobi,i:t  cDi^ivS.  13 

the  genital  canal  has  been  anticipated  in  the 
foregoing  review  of  its  anatomy.  The  really 
essential  element,  whether  it  fmictionates  on 
the  lining  membrane  or  in  a  gland  cavity,  is 
the  epithelial  cell  that  has  acquired  the  habit 
of  elaborating  mucus.  While  a  corium  of 
well  recognized  construction  forms  part  of  a 
typical  mucous  membrane,  this  is  not  indis- 
pensable, as  attested  in  the  lining  of  the 
uterine  corpus ;  nor  are  glandular  bodies  nee- 
essary  to  distinguish  this  tissue. 

The  incentive  for  an  epithelial  cell  to 
elaborate  mucus  can  be  none  other  than  a  re- 
sponse to  a  physiological  demand,  for  it  is 
not  found  that  the  columnar  cells  of  the 
mucous  membrane  differ  from  other  col- 
umnar cells  until  they  undergo  changes 
which  convert  them  into  goblet  cells  in  the 
process  of  mucous  secretion.  Not  all  the  cells 
that  cover  a  mucous  membrane  undergo  this 
change,  for  in  health  the  larger  number  re- 
main simple  columnar  cells,  but  capable  of 
becoming  mucou°  forming  cells  under  the 
stimulus  of  physiological  requirements  or 
pathological  contamination. 

The  elaboration  of  mucus  within  the  pro- 


14  i,e:ucorrh<^a. 

toplasm  of  epithelial  cells  converts  these 
bodies  into  goblet  or  chalice  cells  by  the 
enormous  distention  of  their  walls  with 
mucigen.  The  mucus  is  then  discharged 
from  the  end  of  the  cell,  but  the  subsequent 
fate  of  the  cell  is  uncertain,  for  it  is  not  de- 
termined whether  after  being  freed  of  its 
contents  the  cell  is  reconverted  into  an  ordi- 
nary columnar  cell,  or  whether  it  remains  a 
goblet  cell  to  be  again  filled  wdth  mucus,  the 
acquired  cell  form  and  function  remaining 
permanent.  It  is  probable  that  the  latter 
cycle  is  that  of  healthy  secretion,  but  that 
under  the  incentive  of  disease — catarrh — the 
process  being  rapid,  epithelial  cells  have  not 
time  to  mature,  and  are  cast  off  with  the  dis- 
charge, their  places  being  taken  by  newdy 
formed  bodies.  Such  imperfectly  emptied 
goblet  cells  are  frequently  found  mingled 
wath  the  mucous  and  lymphoid  elements  of 
both  acute  and  chronic  catarrh  of  the  genital 
canal. 

Reference  has  been  made  to  the  alkaline 
reaction  of  the  uterine  secretion,  and  the  acid 
reaction  of  that  of  the  vagina.  These  prop- 
erties do  not  seem  to  depend  upon  a  specializ- 


VAGlNAIv  BACII^IvUS.  15 

ing  function  of  either  the  surface  goblet  epi- 
thelium, or  that  lining  the  mucous  glands 
in  loco.  It  is  more  likely  that  all  mucus  when 
secreted  is  alkaline,  and  that  it  becomes  acid 
in  the  vagina  owing  to  the  presence  of  a 
special  vaginal  bacillus  that  in  health,  ow4ng 
to  the  cervical  plug,  cannot  find  its  way  into 
the  uterus.  The  bacillus  has  a  protective  or 
antagonistic  action  upon  pathogenic  bacteria, 
which,  though  always  present,  cannot  de- 
velop be3^ond  the  capacity  of  disposal  as  long 
as  the  normal  standard  of  acidity  is  main- 
tained. Under  conditions  of  infection,  pa- 
thologic bacteria  are  met  at  the  vulva  by  the 
acid  secretion  of  the  vagina,  and  if  they 
chance  to  pass  this  sentinel  the  mucous  plug 
at  the  OS  acts  as  a  further  barrier  against  in- 
vasion of  the  uterus.  During  the  period  of 
lochial  discharge  the  normal  va<?inal  bacilli 
disappear.  They  are  present  during  preg- 
nancy, and  reappear  under  healthy  condi- 
tions at  the  termination  of  the  puerperium. 

Inasmuch  as  but  few  pyogenic  cocci  can 
live  in  an  acid  medium,  this  reaction  of  the 
vaginal  secretion  is  recognized  as  nature's 
protection  against  the  infection  of  the  uterus 


16  i,i:ucorrhce:a. 

from  without.  Almost  any  variety  of  micro- 
organisms may  be  found  in  the  vulva,  gon- 
ococci,  staphylococci,  streptococci,  and  even 
tubercle  bacilli,  without  invading  the  vagina, 
immunity  being  insured  as  long  as  the  secre- 
tion remains  acid,  and  the  vaginal  bacilli  are 
in  physiological  numbers  and  activity.  The 
normal  secretion  of  the  corpus  uteri  is  a  thin 
colorless  mucoid  fluid,  and  is  free  from 
micro-organisms.  When,  however,  the  cer- 
vical barrier  is  once  broken  down  and  micro- 
organisms enter  the  cavity  of  the  uterus, 
they  multiply  with  great  rapidity  and  give 
rise  to  the  most  serious  diseases  of  the 
female  pelvis. 

The  secretion  of  the  Fallopian  tubes  is  also 
alkaline,  and  in  health  is  free  from  micro- 
organisms. 

A  study  of  the  mucous  membrane  of  the 
genital  canal  brings  out  several  salient  points 
concerning  its  function.  In  common  with 
mucous  membrane  generally  it  serves  the 
purpose  of  protecting  the  surface  from  the 
invasion  of  micro-organisms,  for  mucus  in 
itself  is  not  a  favorable  medium  for  the  de- 
velopment and  growth  of  bacilli,  but  this  se- 


in:^i:ction.  1 


n 


cretion  offers  an  additional  safeguard  in  an 
acid  reaction  at  the  entrance  of  the  canal, 
and  in  the  midway  plug  of  mucus,  such  pre- 
cautions being  necessary  because  of  the 
direct  communication  with  the  peritoneal 
cavity  by  way  of  the  ova  ducts.  Too  much 
stress  cannot  be  laid  upon  this,  nor  would 
it  be  difficult  to  magnify  the  importance  of 
maintaining  a  healthy  state  of  the  mucous 
membrane  of  the  genital  canal.  It  may  with 
safety  be  asserted  that  no  infection  of  the 
uterus  can  take  place  unless  introduced  from 
without,  and  that  this  cannot  be  introduced 
save  mechanically,  or  by  breaking  down  the 
barriers  that  nature  has  constructed  for  de- 
fense. 


CHAPTER  11. 

THE  NATURE  OF  CATARRH  IN  GENERAL — THE 
CAUSES  OF  GYNECOLOGICAL  CATARRH — 
INFECTION CONSTITUTION — ME- 
CHANICAL— EXANTHEMATOUS 
DISEASES. 

Catarrh  is  exclusively  a  product  of  mucous 
membranes.  It  is  a  mucoid  degeneration 
that  finds  its  physiological  type  in  the  mu- 
cous secretion  of  mucous  membrane  and  mu- 
cous glands. 

In  its  simplest  form  the  degeneration 
shows  itself  as  an  excess  of  function.  Goblet 
cells  are  developed  in  larger  numbers,  and 
their  protoplasm  elaborates  a  surplus  of 
mucus.  In  this  manner  physiological  secre- 
tion is  increased,  and  the  first  stage  and  sim- 
plest variety  of  catarrh  exists.  But  the 
perverted  behavior  of  the  goblet  cells  is  not 
long  confined  to  unnecessary  multiplication, 
and  the  excessive  secretion  of  mucus.  The 
cell  wall,  being  enormously  distended,  bursts, 
the  cell  perishes,  and  mingles  as  a  degenerat- 
ed body  with  the  catarrhal  discharge. 


COMPOSITION  01^  CATARRH.  19 

Nor  is  the  pathological  process  limited  to 
these  bodies,  for  early  the  cylindrical  epi- 
thelial cells  that  cover  a  large  area  of  the 
mucous  surfaces,  and  that  do  not  enter  ac- 
tively into  the  elaboration  of  mucus,  begin  to 
multiply  in  excess  of  physiological  require- 
ments. These  are  cast  off,  and  also  go  to 
make  up  the  catarrhal  discharge.  By  grad- 
ual and  certain  stages  further  degeneration 
of  tissue  follows,  the  desquamated  elements 
mingling  with  the  secretion.  In  this  manner 
a  discharge,  at  first  characterized  by  nothing 
more  than  an  excess  over  functional  require- 
ments, assumes  a  positive  and  well  marked 
pathology,  and  a  process  which  in  the  begin- 
ning involved  only  superficial  structures,  the 
epithelial  covering,  progressing,  attacks  the 
corium,  its  basement  and  submucous  layers. 

Even  in  the  early  stages  of  catarrh,  when 
the  condition  represents  no  more  than  an  ex- 
cess of  functional  activity,  the  protective  ser- 
vice of  the  mucous  membrane  is  rendered 
less  effective,  and  the  dangers  of  infection 
from  without  are  in  like  measure  increased. 
In  more  advanced  stages,  M^hen  tissue  de- 
generation has  progressed  to  pus  formation, 


20  I^EUCORRHCEA. 

and  local  destruction  has  involved  the  arter- 
ial, and  venous  walls,  nature's  protective  bar- 
rier is  entirely  broken  down,  not  only  against 
invasion  from  without,  but  the  internal  se- 
cretions, losing  their  acidity,  become  gener- 
ators of  disease,  and  add  to  the  dangers  that 
attend  gynaecological  catarrh. 

All  catarrhs  of  the  genital  canal  have  their 
origin  in  local  congestion  and  irritation.  We 
will  find  this  a  good  working  hypothesis. 
The  irritation,  by  determining  more  blood  to 
the  parts,  stimulates  functional  activity,  and 
results  in  rapid  cell  proliferation,  consequent 
immature  cell  formation,  and  imperfectly 
elaborated  secretion. 

But  when  we  have  said  this  we  have  not 
gone  very  far  in  sounding  the  etiology  of 
gynaecological  catarrh;  we  must  know  the 
causes  of  irritation  before  we  can  success- 
fully grapple  with  the  disease,  either  prevent 
it  or  cure  it  when  fully  developed. 

The  local  causes  of  the  various  irritations 
that  induce  catarrh  of  the  genital  canal,  and 
that  stand  in  the  relation  of  cause  and  effect, 
are  always  microbic,  and  are  introduced 
from  without.     I  have  never  seen  a  case  of 


MICRO-ORGANISMS.  21 

established  catarrh  in  which  there  was  not 
some  degree  of  corium  congestion,  irritation, 
and  an  examination  of  the  discharges  leaves 
no  ground  to  doubt  that  the  cause  always  lies 
in  micro-organisms  that  have  gained  en- 
trance through  the  vagina.  In  other  words, 
catarrh  of  the  genital  canal  is  a  microbic 
disease;  in  kind  similar  to  any  other  infec- 
tion, in  degree  milder  than  many  that  may 
attack  the  mucosa  of  the  uro-genital  system. 

Some  cases,  as  the  catarrh  of  a  young  girl, 
or  of  a  virgin  with  an  almost  imperforate 
hymen,  may  with  difficulty  be  fitted  into  this 
hypothesis,  but  if  we  will  examine  such  cases 
carefully,  their  constitution,  which  may  so 
alter  the  character  of  the  mucous  secre- 
tion as  to  reduce  its  protecting  qualities,  and 
allow  the  ever-present  bacteria  to  penetrate 
below  the  epithelial  lining,  or  inquire  into 
their  conditions  of  life,  there  will  be  found 
a  causa  sine  qua  non,  without  which  the  es- 
sential mucoid  degeneration  could  not  have 
taken  place. 

It  may  be  asked  why  the  severer  varieties 
of  infection,  tubercular,  and  septic,  do  not 
more  frequently  develop  in  the  genital  canal ; 


22  ]:.e:ucorrhce:a. 

why  all  women  are  not  in  danger?  All 
women  are  in  danger,  but  not  always.  As 
long  as  the  secretion  of  the  vagina  remains 
acid,  they  are  immune,  unless,  and  this  is  a 
point  of  the  utmost  importance,  there  is  a 
mechanical  abrasion,  and  the  absorbing  sur- 
faces of  the  corium  are  laid  bare.  The  latter 
is  unlikely  to  occur  in  virgins  who  have  not 
been  examined  vaginally;  but  the  absence  of 
acidity  in  the  vagina  may  be  a  part  of  a  gen- 
eral dyscrasia,  or  of  errors  in  nutrition,  so 
frequently  found  in  connection  with  the  geni- 
tal catarrh  of  girls  and  young  women.  Such 
cases  are  among  the  most  difficult  to  treat, 
for  we  have  no  exact  means  to  determine 
how  far  the  catarrhal  infection  extends,  inas- 
much as  the  vagina  is  a  common  outlet  and 
drain  with  the  uterus.  The  same  hindrance 
opposes  itself  to  exact  diagnosis  in  all  genital 
catarrhs,  but  the  obstacles  are  greater  in 
young  girls  and  unmarried  women,  in  whom 
the  impossibility  of  separating  the  uterine 
from  the  vaginal  secretion  must  always  be 
reckoned  with.  They  may  submit  to  a  dig- 
ital examination,  but  the  use  of  instruments, 
even  a  small  speculum,  will  be  refused,  and 
very  properly  unless  as  a  last  resort. 


CONSTITUTION.  23 

The  mechanical  removal  of  the  protective 
epithelial  covering  is  a  frequent  cause  of 
gynaecological  catarrh.  The  examining 
finger,  the  unskillful  use  of  instruments,  even 
the  vaginal  douche,  may  be  sufficient  to 
abrade  the  mucous  membrane,  and  I  have 
been  led  to  believe  that  rupturing  the  hymen 
during  coitus  has  in  some  instances  been  the 
door  through  which  the  invasion  of  micro- 
organisms took  place. 

A  constitution  under  the  influence  of 
which  there  is  a  vicious  metabolism,  a  per- 
verted function  of  all  the  secreting  organs, 
and  a  tendency  to  the  development  of  im- 
mature cell  forms  and  their  consequent  de- 
generation and  nerosis,  may  lie  at  the  found- 
ation of  many  varieties  of  idiopathic  gynae- 
cological catarrh.  Young  girls  of  a  scrofu- 
lous diathesis  suffer  from  catarrh  of  all  the 
mucous  membranes,  and  are  very  subject  to 
catarrh  of  the  genital  canal.  Adults  who  are 
below  par  offer  a  corresponding  decreased 
resistance  to  microbic  invasion.  Women 
who  are  over-worked  mentally  or  physically, 
women  whose  reparative  processes  are  weak- 
ened, among  the  rich  by  over-eating  and  dTi 


24  I^EUCORRHCDA. 

ennervating  life  from  luxury,  among  the 
poor  by  insufficient  nourishment  and  priva- 
tion, reach  the  same  results,  derangement  of 
gland  function,  perverted  secretions,  and, 
finally,  gynaecological  catarrh  in  one  form  or 
another.  Both  classes  become  subjects  of 
uterine,  ovarian  and  tubal  diseases  that  are 
only  too  frequently  etiological  factors  in 
affections  of  the  genital  mucous  membrane. 
It  is  a  matter  of  frequent  clinical  record 
that  the  exanthematous  diseases,  especially 
measles  and  scarlet  fever,  leave  as  sequelae 
catarrh  of  the  throat,  nose  and  middle  ear; 
quite  as  often  genital  catarrh  may  be  traced 
to  the  same  cause,  a  vaginal  discharge  of 
children  and  of  young  girls  following  an  at- 
tack of  one  of  these  diseases.  Suppressed 
exanthemata  may  also  be  followed  imme- 
diately or  remotely  by  catarrhal  affections  of 
the  genital  canal. 


CHAPTER  III. 

CivASSlFlCATlON     O^     GyN^COI^OGICAI,     Ca- 

TARRH — SiMPivK  Catarrh,  in  Ini^ants 
AND  Chii.dri:n,  Tri:atm^nt,  Locai. — In 
AduIvTs,  Trkatmknt,  Locai,,  Medical — 
In  Young  Giri.s,  Mucopurulent  Ca- 
tarrh (Lkucorrhgp:a),  Adults,  Chil- 
dren, Treatment,  Local,  Constitu- 
tional, Medical — Purulent  Catarrh 
— Senile  Purulent  Catarrh,  Treat- 
ment, Local,  Operative,  Curettage, 
Trachelorrhaphy,  Constitutional, 
Medical  —  Sanguinous  Catarrh, 
Treatment,  Medical — Sanguinous, 
Senile  Catarrh,  Treatment. 

The  most  practical  and  useful  classifica- 
tion of  gynaecological  catarrh  is  based  on 
clinical  data  so  far  as  they  are  concerned 
with  the  character  of  the  discharge.  A  more 
accurate  and  scientific  arrangement  would 
consider  the  anatomical  divisions  of  the  gen- 
ital canal  from  which  the  discharge  could  be 
demonstrated  to  take  place,  as  vulvar  ca- 


26  i,e:ucorrhce:a. 

tarrh,  vaginal  catarrh,  uterine  catarrh,  and 
tubal  catarrh,  but  while  it  might  be  possible 
to  establish  such  distinctions  in  the  earliest 
stages  of  the  disease,  the  fact  that  the  mor- 
bid action  does  not  long  remain  confined  to 
the  part  in  which  it  originates,  resulting  in 
mixing  the  flow  from  the  several  regions  and 
consequent  blurring  of  clinical  features,  ren- 
ders it  impracticable  to  allow  the  anatomical 
or  even  functional  divisions  of  the  canal  to 
be  a  basis  for  classification.  Catarrh  origi- 
nating in  the  vagina  may  soon  spread  to  the 
uterus,  and  the  disease  starting  in  the  uterus, 
if  it  does  not  actually  involve  the  mucous 
membrane  of  the  outermost  canal,  mingles 
its  discharge  with  that  from  the  healthy 
vagina.  As  a  matter  of  fact,  gynaecological 
catarrh  is  a  composite  discharge,  being  made 
up  of  the  secretions  from  the  entire  genital 
canal,  that  special  element  predominating 
w^hich  represents  the  most  active  pathologi- 
cal focus. 

It  is,  therefore,  obvious  that  the  most  prac- 
tical demonstration  of  gynaecological  catarrh 
will  consider  the  character  of  the  discharge 
according  to  its  various  modifications  which 


CI^ASSIi^ICATlON.  27 

depend  upon  the  specific  cause,  length  of 
duration,  extent  of,  and  degree  of  tissue  in- 
volvement. 

The  following  classification  will  be  adopt- 
ed: 

A.  SiMPLK  Catarrh. 

Usually  involving  only  the  mucous  mem- 
brane of  the  vagina  and  vulva,  and  rep- 
resented by  an  increased  secretion  of 
mucus  that  contains  few  cellular  ele- 
ments. 

B.  MucopuRuivKNT    Catarrh     (Leucor^ 

rhc^a). 
An  outgrowth  of  simple  catarrh,  marking, 
however,    a   distinct   pathological   pro- 
cess, with  more  or  less  destruction  of 
tissue  and  an  admixture  of  pus  cells. 

C.  PuRUi^ENT  Catarrh. 

This  may  be  the  third  stage  of  simple  ca- 
tarrh, the  mucous  character  disappear- 
ing in  favor  of  the  more  intense  bacteri- 
cidal infection,  or,  though  more  rarely, 
it  may  arise  as  a  primary  disease  from 
the  direct  invasion  of  pyogenic  cocci. 
The  discharge  is  almost  pure  pus,  the 
cast  off  epithelial  cells  mingling  with 
cast  off  purulent  exudation. 


28  I^^UCORRHC^A. 

D.     Sanguinous  Catarrh. 

The  discharge  is  characterized  by  a  pre- 
dominating admixture   of   blood   cells, 
and  indicates  a  distinct  involvement  of 
the   deeper   structures   of   the   mucous 
membrane,  and  a  degree  of  inflamma- 
tion in  which  the  integrity  of  the  capil- 
lary wall  is  attacked,  allowing  transuda- 
tion of  red  blood  corpuscles. 
A  further  division  into  acute  and  chronic 
catarrh  is  possible,  but  any  one  of  the  above 
varieties  may  be  either  acute  or  chronic,  and, 
therefore,  such  a  separation  serves  no  well 
defined  purpose.    In  the  matter  of  treatment 
the  history  of  the  disease  that  has  lasted  over 
a  considerable  length  of  time  presupposes 
more  or  less  profound  systemic  involvement, 
and  as  such  will  receive  special  treatment 
directed  to  the  chronic  condition. 

A.     S1MP1.E:  Gyn^coi^ogicai,  Catarrh. 

This  occurs  most  frequently  in  children 
and  young  adults.  It  is  usually  confined  to 
the  vulva  and  vagina,  rarely  involving  the 
uterus.  The  process  consists  in  an  increase 
of  the  functional  activity  of  the  mucous  cells 


MKASIvES    AND    SCARI^KT    Fi:vi:R.  29 

and  glands,  resulting  in  an  undue  secretion 
and  discharge  of  mucus.  Goblet  cells,  either 
intact  or  ruptured,  are  found  in  the  dis- 
charge, and  epithelial  cells  in  various  stages 
of  transition  into  mucus  cells.  The  dis- 
charge is  a  glairy  transparent  mucus,  unless 
the  vulvar  glands  are  involved,  when  it  be- 
comes mixed  with  secretion  from  the  sebace- 
ous glands  of  the  vulva  and  the  glands  of 
Bartholin,  rendering  the  discharge  opaque, 
and  sometimes  cheesy. 

Catarrh  of  this  variety  is  not  incompatible 
with  a  feeble  acid  reaction  of  the  vaginal  se- 
cretion, but  a  more  advanced  and  pronounced 
degree  of  simple  catarrh  is  accompanied  with 
a  neutral  or  alkaline  reaction.  Such  dis- 
charges are  irritating,  and  frequently  give 
rise  to  troublesome  vulvitis  and  vaginitis.  In 
infants  this  is  not  uncommon,  for  with  them 
and  the  new  born  the  normal  reaction  is 
neutral.  This  fact  may  explain  their  suscep- 
tibility to  vaginal  catarrh;  certain  it  is  that 
the  absence  of  acidity  favors  the  invasion  of 
micro-organisms  in  these  cases. 

The  important  part  played  by  measles  and 
scarlet  fever  in  causing  genital  catarrh  in 


30  I^EUCORRHCEA. 

little  girls  has  been  referred  to.  I  believe 
this  to  be  more  common  than  is  generally  ad- 
mitted. The  pruritus  attending  this  variety 
of  catarrh  in  children  is  sometimes  intense, 
and  may  be  the  first  symptom  to  attract  at- 
tention, for  the  discharge  is  not  usually  very 
marked. 

In  simple  catarrh  of  infants  and  children, 
examination  shows  the  vulva  to  be  inflamed 
and  swollen,  the  redness  extending  into  the 
vagina.  Urination  is  frequent  and  painful, 
and  the  patient  is  in  constant  motion,  rub- 
bing the  parts  together,  or  seeking  to  relieve 
the  itching  by  scratching.  The  habit  of 
masturbation  may  have  its  origin  in  this  in- 
tense irritation  of  the  genital  organs,  and 
the  means  taken  to  obtain  relief. 

From  the  unrest  caused  by  local  irritation 
and  the  erethism  of  erectile  tissue  that  fol- 
lows, the  general  health  of  these  little  pa- 
tients soon  suffers.  They  become  irritable, 
nervous  and  easily  excited.  Children  who 
have  always  been  most  even  tempered,  from 
very  trifling  causes,  fly  into  a  violent  passion. 
They  are  restless  at  night,  waking  at  short 
intervals.       Their     digestion     suffers,     the 


ivOCAi,  trkatme:nt.  31 

tongue  is  coated,  and  there  is  obstinate  con- 
stipation. So  marked  are  these  symptoms  of 
some  genital  irritation  that  I  always  think 
of  catarrh  when  such  a  case  is  presented,  and 
by  physical  examination  assure  myself  of  the 
condition  of  the  vulva  and  vagina. 

It  is  useless  and  a  detriment  to  our  heal- 
ing art  to  attempt  to  cure  these  cases  or  any 
case  of  gynaecological  catarrh  with  internal 
medicine  alone.  As  it  is  a  local  manifestation, 
local  applications  will  form  an  indispensable 
part  of  any  rational  treatment,  even  in  in- 
fants and  young  children.  The  disease  has  a 
microbic  origin,  and  these  organisms  must  be 
attacked  in  situ,  removed  and  their  multipli- 
cation arrested,  and  their  environment  made 
unfavorable  for  further  development.  In- 
ternal remedies  will  dynamically  restore  the 
health  of  the  tissues  and  render  them  unfit 
to  harbor  or  generate  microbic  life.  The 
simple  gynaecological  catarrh  of  infants 
seldom  becomes  mucopurulent  unless  to  it  is 
added  a  specific  infection. 

The  indications  for  the  local  treatment  of 
the  catarrh  of  infants  and  young  girls  before 
the  advent  of  puberty — after  that  period 


32  i,Kucorrhce:a. 

questions  connected  with  the  development  of 
the  entire  reproductive  system  will  merit 
consideration — are,  first,  to  destroy  the  caus- 
ative micro-organisms,  and  second,  to  allay 
irritation,  wdiich,  in  its  turn,  will  control  in- 
flammation. 

Tn  simple  genital  catarrh  the  infection  is  a 
mild  one,  and  will  usually  yield  to  mild  bac- 
tericides. Even  though  it  has  passed  the 
acute  stage  and  become  chronic,  the  chron- 
icity  is  not  due  to  an  increase  of  virulence, 
but  to  a  vicious  habit  of  cell  multiplication 
and  the  extravagant  elaboration  of  mucus 
brought  about  by  infecting  bodies.  As  a 
rule,  the  catarrhal  process  does  not  extend 
beyond  the  external  os.  The  lower  segment 
of  the  uterus,  which  is  proportionally  longer 
than  the  fundus  until  puberty,  remains  closed 
with  its  mucous  plug. 

Boracic  acid  usually  suffices  for  a  cure. 
The  method  of  its  use,  however,  is  import- 
ant. A  douche,  or  lotion,  in  the  proportion 
of  one  drachm  in  one  pint  of  sterile  water  at 
a  temperature  not  above  100  meets  the  re- 
quirements for  a  solution,  but  sometimes  for 
the  irritation  of  the  vulva,  especially  if  it  is 


VUI.VAR    IRRITATION.  33 

eczematous,  an  ointment  is  required.  For 
this  purpose  I  use  Boracic  acid  ointment,  U. 
S.  P.,  or  the  Glycerite  of  starch;  either  one 
of  which  will  be  found  most  soothing  to  the 
irritated  surface,  and  will  reduce  the 
brawny  condition  of  the  labia.  If  there  is 
much  swelling  and  denudation  of  epithelium 
the  following  will  be  very  efficacious : 

?.     Calomel 1  gramme. 

Tannin    2  grammes. 

Glycerite  of  starch. 20  grammes. 

This  may  be  smeared  over  the  parts,  or  ap- 
plied on  strips  of  old  sterilized  linen,  which  I 
find  very  useful  in  gynaecological  practice. 

Or  a  pencil-shaped  suppository  of  the  fol- 
lowing may  be  introduced  between  the  labia : 

19.     vSalol    grs.   Iss. 

Cocoa  butter gr.  xv. 

M. 

The  use  of  the  vaginal  douche  in  these 
cases  becomes  a  matter  for  serious  consider- 
ation. It  goes  without  saying  that  it  should 
never  be  used  in  children  if  it  can  possibly 
be  avoided,  and  in  many  cases  it  is  not  neces- 
4 


34  I,EUCORRH(HA. 

sary,  for  the  pathological  process  when  origi- 
nating in  the  vulva  frequently  does  not  in- 
vade the  vagina,  and  can  be  treated  by  ob- 
serving strict  cleanliness,  and  bathing  with  a 
Boracic  acid  lotion.  The  parts  can  be  cleans- 
ed by  directing  a  gentle  stream  of  Boracic 
solution  against  them,  going  well  up  to  the 
hymen.  It  is  of  the  utmost  importance  to 
remove  all  discharge  from  every  crease  and 
fold,  and  to  bring  the  medication  in  contact 
with  the  entire  mucous  surfaces.  After  dry- 
ing, Boracic  ointment  or  Glycerite  of  starch 
may  be  applied  if  necessary.  I  generally  give 
the  preference  to  the  Glycerite  of  starch. 

When  the  vagina  is  involved  it  may  be- 
come advisable  to  use  a  douche.  With  care 
this  can  be  done  without  mutilation  unless 
the  hymen  is  almost  imperforate.  This  con- 
dition of  the  hymen  by  interfering  with 
drainage  may  intensify  the  local  process,  and 
require  to  be  separately  dealt  with.  I  have 
met  several  such  instances  in  little  girls. 
The  opening  in  the  hymen  would  scarcely 
admit  a  small  probe,  and  the  pent  up  catar- 
rhal discharge  encouraged  conditions  favor- 
able for  its  continuance  and  induced  further 


impi^ri^orate:  hyme:n.  35 

mucoid  degeneration.  An  enlargement  of 
the  opening  in  the  hymen,  and  a  few  Boracic 
acid  douches,  sometimes  Potassium  per- 
manganate 1/2000,  will  be  of  more  service, 
usually  suffice  to  effect  a  cure.  In  one  of  the 
instances  I  recall  the  child  was  eight  years 
old.  The  catarrh  had  spread  from  the  vulva 
into  the  vagina.  All  of  the  structures  involv- 
ed were  in  a  state  of  intense  irritation.  The 
discharge  was  distinctly  alkaline,  and  very 
offensive.  The  opening  in  the  hymen  was 
difficult  to  find,  and  was  finally  discovered  by 
a  drop  of  mucus  that  oozed  into  the  vagina. 
An  enlargement  of  the  opening  and  Boracic 
acid  douches  promptly  restored  the  mucous 
membrane  to  health. 

Children  of  this  as:e,  or  older,  should  never 
be  allowed  to  use  the  douche  themselves;  it 
should  always  be  given  by  the  mother,  nurse, 
or  some  adult  member  of  the  family.  The 
physician  should  carefully  instruct  the  per- 
son who  is  to  carry  out  his  orders,  and  if 
the  entire  matter  is  treated  in  a  perfectly 
simple  matter  of  fact  manner  the  patient's 
modesty  will  not  be  offended  nor  will  her 
mind  dwell  unduly  upon  the  subject. 


36  I^EUCORRHOSA. 

Simple  gynsecological  catarrh  in  adults  is 
the  most  frequent  form  of  catarrh  encount- 
ered by  the  gynaecologist,  and  may  vary  in 
quantity  from  a  scarcely  increased  physi- 
ological discharge  to  a  profuse  debilitating 
flow.  The  character  of  the  discharge  re- 
mains the  same,  but  the  surfaces  involved  are 
most  extensive,  the  morbid  processes  spread- 
ing to  the  mucosa  covering  the  portio-vagin- 
alis,  and  even  to  the  cervical  endometrium. 
This  variety  of  gynaecological  catarrh  is 
sometimes  called  leucorrhcea — fluors  alba — 
for  it  may  be  milky  white  from  the  admixt- 
ure of  cast  off  epithelial  cells. 

In  virgins  it  is  usually  associated  v/ith  dis- 
placement of  the  uterus,  congestion  of  the 
ovaries,  or  general  pelvic  congestion ;  in  mar- 
ried women  it  may  be  connected  with  defect- 
ive sexual  hygiene,  or  when  a  part  of  a  multi- 
para's histor}^,  with  subinvolution  of  the 
uterus.  Any  cause  that  induces  chronic  con- 
gestion of  the  pelvic  organs  and  structures 
may  be  looked  upon  as  most  potent  in  the 
etiology  of  simple  gynaecological  catarrh. 

The  treatment  advocated  for  simple  ca- 
tarrh in  infants  and  young  girls  will  also  be- 


te:chnique:  o^  douche:.  37 

found  useful  for  the  disease  in  adults.  Pa- 
thologically, there  is  little  difference  between 
the  two  manifestations  of  catarrh.  A 
Boracic  acid  douche  and  ointment,  or  an 
ointment  made  with  the  glycerite  of  starch 
have  for  pruritus  their  well-defined  places 
as  curative  agents,  but  with  the  adult  the 
vaginal  douche  and  direct  local  medication 
necessarily  fill  a  more  prominent  place  than 
in  children.  When  the  inflammation  sub- 
sides somewhat  an  astringent  solution  is  of 
service,  1  to  200  of  lead  acetate,  or  1  in  40 
solution  of  glycerite  of  tannin. 

The  method  of  giving  a  vaginal  douche 
will  vary  according  as  it  is  desired  to  retain 
the  medication  for  a  length  of  time  in  con- 
tact with  the  mucous  membrane,  or  the  ob- 
ject is  for  cleansing  purposes  chiefly.  For 
simple  uncomplicated  catarrh  the  latter  will 
suffice,  and,  with  this  in  view,  the  following 
technique  will  be  found  convenient,  and  to 
yield  satisfactory  results : 

The  patient  will  sit  on  a  douche  pan,  or, 
better  still,  on  a  commode  with  the  thighs 
well  separated.  A  reclining  position  retains 
the  solution  in  the  vagina,  and  does  not  per- 


38  I^I^UCORRHCE^A. 

mit  thorough  cleansing  of  the  canal.  There- 
fore, I  have  my  patients  sit  while  irrigating 
the  vulva  and  when  taking  a  douche. 

There  should  not  be  a  famil}^  douche  bag, 
each  patient  should  have  her  own  instrument 
reserved  for  her  exclusive  use.  This  must  be 
insisted  upon,  for  the  custom  of  having  one 
bag  with  several  tips  cannot  be  too  strongly 
condemned. 

Before  used,  the  bag  and  tips  should  be 
cleansed  and  boiled,  and,  thereafter  when  not 
in  use,  kept  in  a  solution  of  boracic  acid. 
The  ordinary  hard  rubber  tip  is  convenient  in 
size  and  shape,  but  I  prefer  one  made  of 
glass.  Any  soiling  can  then  be  easily  de- 
tected. This  is  not  true  of  the  hard  rubber 
tips.  These,  however,  can  be  made  perfectly 
clean,  and  with  the  aid  of  boiling  water,  or 
an  alcohol  flame,  be  moulded  to  any  desired 
shape.  Before  heating  the  tip  in  an  alcohol 
flame  it  should  be  smeared  with  vaseline  to 
prevent  burning  the  rubber.  Hard  rubber 
tips  have  one  advantage  over  glass,  they  do 
not  break  easily,  and  no  risk  is  run  of  injur- 
ing the  patient  while  taking  the  douche.  I 
have  known  several  quite  severe  accidents 


TDMPE^RATUR^  01^  THE)  DOUCHE).  39 

to  occur  by  the  glass  tip  breaking  when  in  the 
vagina. 

Little  force  is  necessary  for  the  stream  of 
water.  The  douche  bag  should  be  hung 
about  on  a  level  with  the  patient's  head.  If 
the  solution  when  poured  in  the  bag  is  110° 
F.,  it  will  be  the  proper  temperature  when  it 
reaches  the  body.  I  will  here  enter  my  pro- 
test against  the  high  temperature  douche  un- 
less as  a  continuous  irrigation  in  pelvic  cellu- 
litis. The  temporary  relief  afforded  by  the 
heat  induces  a  more  or  less  permanent  relax- 
ation of  tissues,  which  eventually  accentu- 
ates the  very  conditions  it  is  used  to  correct. 
As  a  therapeutic  agent  in  the  treatment  of 
catarrh  the  vaginal  douche  should  not  be 
above  105°  F. 

To  minimize  the  danger  of  adding  to  vag- 
inal infection  the  external  parts  should  be 
douched  before  the  vagina.  Ordinarily  two 
quarts  of  water  will  be  sufficient  to  cleanse 
both  the  vulva  and  the  vagina,  but  if  the  ca- 
tarrh is  very  tenacious  it  may  be  necessary  to 
first  use  a  pint  of  bicarbonate  of  soda  solu- 
tion, soda  one  ounce,  water  one  pint,  to  cut 
the  discharge,  and  permit  the  boracic  acid  to 
come  in  contact  with  the  mucous  membrane. 


40  LKUCORRHC^A. 

If  there  is  sufficient  vulvitis  to  necessitate 
special  treatment,  the  parts  should  first  be 
thoroughly  dried,  and  then  one  of  the  gly- 
cerites  I  have  mentioned  applied,  either  as  a 
smear  or  on  pieces  of  linen  laid  between  the 
labia. 

It  is  desirable  to  avoid  retention  of  the 
irritating  discharges,  and  to  prevent  them 
from  remaining  in  contact  with  the  vulva, 
also  to  avoid  the  use  of  heat  producing  vulvar 
pads.  At  the  same  time  the  catarrh  may  be 
so  profuse  as  to  require  a  protective  dress- 
ing. The  rule  for  dressing  should  be  as  light 
an  antiseptic  pad  as  possible,  renewed  as 
often  as  necessary.  One  or  tw^o  layers  of 
absorbent  cotton  wrapped  in  sterile  gauze 
wall  answer  the  purpose,  and  before  saturat- 
ed it  should  be  changed. 

In  case  the  discharge  is  corrosive,  and  this 
will  be  increased  by  the  urine  passing  over 
the  sensitive  parts,  a  stiff  boracic  acid  oint- 
ment will  afford  relief.  Stearate  of  zinc  may 
also  be  dusted  over  the  vulvar  pad. 

I  have  advocated  especially  a  boracic  acid 
douche.  This  has  in  my  hands  been  the  most 
generally  useful  in  the  treatment  of  simple 


BORACIC   ACID   DOUCHK.  41 

catarrh.  It  allays  the, itching  of  vaginismus, 
and  at  the  same  time  furnishes  the  required 
bactericide.  Occasionally  I  add  glycerine  in 
the  proportion  of  one  ounce  to  a  quart  of 
water,  or  when  the  mucous  membrane  is  in- 
tensely congested  I  inject  an  ounce  of  sterile 
glycerine  into  the  vagina  after  the  douche 
has  been  given.  The  patient  should  then  be 
kept  in  the  recumbent  position  to  retain  the 
glycerine  in  the  canal  as  long  as  possible. 
An  availment  of  the  hygroscopic  action  of 
glycerine  will  do  much  towards  the  success 
of  any  subsequent  local  treatment  that  may 
be  instituted.  Some  cases  may  call  for  a 
carbolic  acid  douche,  others  for  bichloride 
of  mercury,  still  others  for  creoline,  but  in 
my  hands  boracic  acid  has  been  so  entirely 
satisfactory  in  the  treatment  of  simple  ca- 
tarrh that  I  have  come  to  rely  upon  it,  and  to 
reserve  the  more  powerful  germicides  for 
the  severer  adult  cases,  in  whom  there  is 
liable  to  be  a  mixed  infection. 

In  the  general  treatment  of  gynaecological 
catarrh  the  hygiene  of  the  patient  must  be 
carefully  regulated.  Digestion  should  re- 
ceive especial  attention,  and  the  several  func- 


42  ]:,e:ucorrh(i:a. 

tions  of  elimination  encouraged  to  their  full 
activity.  Any  tendency  to  constipation  must 
be  overcome  by  the  use  of  salines,  in  mild 
cases  preferably  the  phosphate  of  soda;  in 
more  chronic  cases  it  may  be  necessary  to  re- 
sort to  Rubinat  condal,  or  Hunyadi  water. 
Cascara  is  useful  for  children.  The  estab- 
lishment of  a  cathartic  habit  is  greatly  to  be 
deprecated,  but  it  is  useless  to  attempt  to 
cure  a  torpid  intestinal  canal  with  dynamic 
medicines  while  it  remains  mechanically  full. 
Remove  the  accumulation,  which  from  its 
very  presence  paralyzes  the  muscular  wall, 
establish  the  habit  of  forcing  the  faecal  mass 
onward,  and  the  cause  of  the  trouble  may  be 
reached  with  the  indicated  remedy.  Consti- 
pation in  children  and  young  girls  is  attended 
if  not  caused  by  packing  of  the  sigmoid  colon 
with  fseces.  The  rectum  also  becomes  filled 
and  sluggish.  This  operates  mechanically, 
favoring  congestion  of  the  pelvic  organs,  the 
very  condition  it  is  desired  to  overcome. 

The  remedies  for  simple  gynaecological 
catarrh  will  cover  a  wide  range  of  drugs,  but 
the  selection  will  usually  be  made  from 
among  a  comparatively  small  number,  for  in 


sDi^ijcTioN  oi^  ri:mi:die:s.  43 

seeking  the  similimum  a  few  symptoms  will 
serve  as  a  basis  upon  which  to  build  each 
therapeutic  structure,  these  are  the  guiding 
symptoms  of  the  drug,  and  the  essential 
symptoms  of  the  disease.  Adapting  one  to 
the  other  makes  a  perfect  prescription.  The 
genius  of  the  drug  fitted  to  the  genius  of  the 
malady  constitutes  scientific  therapeutics. 

In  the  treatment  of  the  simple  catarrh  of 
children  and  young  girls,  I  have  generally 
obtained  the  best  results  from  Merc.  jod.  2, 
or  Sepia,  Calcarea  carb.,  or  Phosphorus,  the 
latter,  if  there  is  much  pruritus  and  local  irri- 
tation, will  be  thought  of.  The  scrofulous 
diathesis  suggests  Bromine  or  Iodine,  either 
one  of  which  remedies  will  bear  careful 
study  in  these  cases.  When  there  is  evident 
sexual  excitement,  this  may  manifest  itself 
in  a  variety  of  ways,  no  remedy  equals 
Origanum.  Caulophyllum  is  also  useful 
when  the  discharge  is  very  profuse  and  acrid. 
When  there  is  reason  to  associate  the  genital 
catarrh  with  suppression  of  exanthemata,  or 
to  regard  it  as  one  of  the  sequelae,  Phosphoric 
acid  will  be  of  service.  Baryta  carb.  has 
been  of  service  in  the  treatment  of  simple  ca- 


44  I^IJUCORRHOeA. 

tarrh  in  young  women  who  are  always  tired. 
Sepia  when  there  is  pronounced  misplace- 
ment of  the  uterus.  Frequently  catarrh  in 
young  women  is  associated  with  some  dis- 
appointment connected  with  the  affections, 
disappointed  love.  Here  Calcarea  phos.  will 
render  excellent  service.  Ambitious  students 
are  often  the  subjects  of  gynaecological  ca- 
tarrh ;  we  will  think  of  Gelsemium.  Helonias 
will  cure  many  cases  of  simple  catarrh  in 
women  enervated  from  luxury.  The  pelvic 
structures  are  lax  and  soft.  Nervous  ex- 
haustion, so  frequently  an  accompaniment  of 
genital  catarrh,  always  suggested  that  great 
tissue  remedy,  Kali  phos.  Pulsatilla,  Lilium 
tig.  and  a  remedy  usually  more  frequently  as- 
sociated with  other  forms  of  catarrh,  Thuja, 
I  have  found  useful  in  the  simple  variety, 
especially  when  there  is  much  local  irritation. 
In  connection  with  a  douche  of  this  same 
remedy,  one  drachm  in  a  quart  of  water,  it 
will  yield  most  satisfactory  results. 

B.     MucopuRUi^ENT  Catarrh. 

Simple  catarrh  may  continue  through  all 
phases  of  life,  it  may  become  chronic  even 


utkrine  catarrh.  45 

before  puberty,  and  persist  without  material 
changes  during  menstrual  life  in  unmarried 
women.  More  frequently,  however,  the 
vaginitis  that  is  carried  over  into  the  repro- 
ductive period  becomes  mucopurulent  by  the 
addition  of  pus  cells,  the  micro-organisms  be- 
ing pyogenic,  and  the  vaginitis  representing 
a  more  profound  tissue  involvement. 

With  the  functional  development  of  the 
upper  part  of  the  genital  canal,  the  uterus, 
and  the  Fallopian  tubes,  the  catarrhal  pro- 
cess extends,  and  to  the  vaeinal  catarrh  prior 
to  puberty  is  added  catarrh  of  the  uterus. 
The  functional  activity  that  attends  repro- 
ductive life,  the  normal  increase  in  glandular 
development  and  the  consequent  changes  in 
the  lining  epithelium  of  the  genital  canal  that 
is  a  part  of  each  menstruation,  introduce 
factors  until  then  not  reckoned  with,  factors 
that  so  dominate  the  gynaecological  catarrh 
of  adolescence  and  married  life  as  to  almost 
warrant  their  consideration  as  a  separate 
class.  But  the  divisions  according  to  age  are 
broken  down  in  view  of  the  fact  that  pa- 
thologically identical  gynaecological  dis- 
charges may  occur  at  any  period  of  life  irre- 
spective of  social  conditions. 


46  I^EUCORRHC^A. 

With  the  advent  of  reproductive  life  there 
is  an  augmented  activity  of  the  genital 
mucosa  and  a  corresponding  increase  of  dis- 
charge, this  functionating  continuing  under 
the  regulation  of  physiological  requirements 
until  the  folding  up  process  is  completed. 
The  secretion  of  mucus  varies  greatly  in  in- 
dividuals, and  within  limits  is  not  incompati- 
ble with  health.  That  is  to  say,  a  discharge 
considered  normal  during  adolescence  and 
maturity  would,  with  propriety,  be  looked 
upon  as  abnormal  if  occurring  in  childhood, 
a  veritable  catarrh  even  though  the  character 
of  the  discharge  continues  unchanged  and  is 
physiological  in  its  constituents.  When, 
however,  the  simple  catarrh  of  childhood 
continues  into  menstrual  life,  or  develops 
after  puberty,  it  is  frequently  of  the  muco- 
purulent variety,  and,  therefore,  while  this 
catarrh  may  occur  at  any  period  of  life  it  is 
the  form  most  frequently  associated  wath 
maturity. 

Mucopurulent  catarrh  is  the  expression  of 
more  than  a  simple  increase  of  the  mucus 
forming  function.  It  represents  a  true  vag- 
initis, and  pathologicaly  is  allied  to  inflam- 


mucopuruIvE:nt  catarrh.  47 

mation  of  the  deeper  structures  of  the  genital 
canal.  The  portio-vaginalis  is  always  in- 
volved, but  as  long  as  the  morbid  process  is 
confined  to  the  mucus  forming  epithelia,  and 
mucus  predominates  in  the  discharge,  the 
cervical  canal  is  not  invaded  above  the  ex- 
ternal uterine  os. 

Be3^ond  a  slight  degree  of  congestion  the 
vulva  is  not  usually  affected  unless  through 
neglect  of  cleanliness ;  the  parts  are  kept  con- 
stantly bathed  in  the  discharge,  which,  unless 
removed  frequently,  may  be  irritating  and 
corrosive.  The  vagina,  however,  is  highly 
congested,  and  the  epithelial  cells  and  glands 
are  excited  to  an  unusual  degree  of  activity, 
mucus  being  secreted  in  enormous  quantities. 

The  pus  cells  which  give  a  purulent  char- 
acter to  the  discharge  come  from  the  portio- 
vaginalis  and  the  mucous  membrane  cover- 
ing the  external  os,  and  are  generated  by 
structural  change  in  these  parts  of  the  canal, 
the  extent  of  which  determines  the  relative 
proportion  of  pus  cells  in  the  discharge. 

A  mucopurulent  gynaecological  catarrh, 
therefore,  is  usually  a  simple  mucous  ca- 
tarrh to  which  is  added  a  characteristic  pa- 


48  i,kucorrhce:a. 

thology  of  the  upper  part  of  the  vagina  and 
portio-vaginalis,  the  discharges  from  which 
give  it  its  characteristic  features.  Hence  in 
considering  this  variety  of  catarrh  attention 
will  appropriately  be  directed  more  especially 
to  these  parts  of  the  genital  canal. 

So  frequently  is  erosion  of  the  uterine  os, 
and  hyperplasia  of  its  glandular  structures 
associated  with  mucopurulent  catarrh  that 
the  propriety  of  regarding  these  conditions 
as  essential  parts  of  a  whole  admits  of  little 
question. 

Erosion  of  the  cervix  is  not  an  ulceration. 
There  is  no  loss  of  tissue ;  on  the  contrary  we 
find  an  increase  of  tissues,  the  condition  be- 
ing more  accurately  described  as  a  sessile 
adenoma.  The  process  centers  in  the  glands 
of  the  cervix,  which  are  normally  complicat- 
ed, and  much  larger  than  those  of  the  body  of 
the  uterus.  The  red  patches  on  the  cervix 
from  which  pus  exudes  are  masses  of  gland 
acini,  and  not  only  occupy  the  surface  of  the 
cervix  but  extend  deeply  into  the  underneath 
tissues.  The  glandular  construction  is  great- 
ly exaggerated,  with  wide  convolutions  and 
dilatations,  the  secreting  parts  increasing  at 


I^CTROPIUM.  49 

the  expense  of  the  stroma  into  which  they 
project. 

The  mucous  membrane  covering  the  seg- 
ment of  the  uterus  that  projects  into  the 
vagina  in  acute  cases  is  highly  congested,  the 
superficial  vessels  being  only  lightly  covered 
with  epithelium.  In  chronic  cases  the  mucosa 
appears  almost  purple  from  blood  stasis,  a 
condition  that  may  spread  to  the  vaginal 
fornices.  The  cervical  endometrium  is  swol- 
len and  pouting  from  the  external  os,  ectro- 
pium,  and  the  normal  rugse  become  accentu- 
ated. All  the  structures  involved  are  more  or 
less  cedematous,  the  portio-vaginalis  appear- 
ing as  a  tumefaction  that  occupies  the  upper 
part  of  the  vagina. 

Though  the  mucous  membrane  is  extreme- 
ly red,  resembling  a  piece  of  raw  meat,  one  is 
surprised  to  find  upon  attempting  to  cleanse 
the  surface  that  it  does  not  bleed  readily.  As 
a  matter  of  fact,  the  apparently  denuded  sur- 
faces are  covered  with  a  thin  layer  of  squam- 
ous epithelium  through  which  the  dilated 
vessels  show  distinctly.  It  is  characteristic 
of  erosion  of  the  cervix  that  the  line  of  de- 
marcation   between    the    morbid    and    the 

5 


so  I,EUCORRH(HA. 

healthy  processes  is  very  clearly  defined,  for 
while  there  is  intense  congestion  of  the 
portio-vaginalis  where  the  glandular  hyper- 
plasia ends  is  always  clearly  marked.  This 
feature  does  not  belong  to  any  other  benign 
growth,  and  disappears  as  the  pathology  be- 
comes more  complex. 

Save  in  advanced  cases  the  uteri  os  is  not 
open.  It  remains  closed  with  a  plug  of  clear 
tenacious  mucus  which  serves  to  guard  the 
interior  of  the  uterus  against  the  invasion  of 
micro-organisms  by  way  of  the  vagina.  This 
plug  can  be  drawn  out  in  a  long  string,  but  is 
dislodged  with  difficulty. 

Mucopurulent  catarrh  may  be  acute  or 
chronic,  more  frequently  the  latter,  as  the 
acute  condition  that  induces  the  formation 
of  pus  causes  a  predominance  of  these  ele- 
ments from  the  outset.  Mucopurulent  gyn- 
aecological catarrh,  therefore,  is  usually  a 
chronic  disease.  It  belongs  to  adult  life  more 
especially,  and  is  connected  with  the  period 
of  sexual  activity.  Conditions  of  life  are 
mainly  responsible  for  mucopurulent  ca- 
tarrh, for  it  is  most  frequent  in  married  life, 
and  in  those  who  have  borne  children.  Elimi- 


E^NDOCDRVICITIS.  51 

nating  gonorrhoea,  which  for  reasons  already 
stated  will  not  be  discussed  here,  the  conse- 
quences of  child-bearing  are  the  most  pro- 
lific causes.  These  are,  imperfect  involution 
of  the  uterus,  quite  as  important  the  injuries 
of  the  lower  segment  of  the  uterus  and  of  the 
vaginal  walls  that  are  incident  to  parturition. 
These  injuries  cannot  always  be  considered 
lacerations,  which  understanding  is  usually 
reserved  for  tears  involving  the  several 
structures  of  the  cervix  and  perineum,  for 
there  is  no  doubt  that  in  some  instances  in 
which  the  cervix  and  vagina  appear  not  to  be 
injured,  indeed  in  which  the  integrity  of  their 
muscular  structures  remains,  the  mucosa  has 
suffered  some  slight  and  overlooked  trauma, 
is  torn,  and  offers  an  entrance  for  micro- 
organisms and  a  point  for  delayed  repair. 
Endocervicitis  follows.  The  cervical  glands 
become  enlarged,  their  function  perverted, 
and  almost  as  a  continuation  of  the  puer- 
perium  there  is  an  erosion  of  the  cervix,  and 
an  infection  of  the  vagina.  When  the  cervix 
is  lacerated  the  steps  to  the  development  of 
erosion  are  more  rapidly  taken,  and  the  end 
more  quickly  reached.     There  is  also  liable 


52  i,e:ucorrhcka. 

to  be  an  arrest  of  the  process  of  uterine  in- 
volution as  a  consequence  of  injury,  tissue 
changes,  and  local  interference  with  nutri- 
tion. 

Women  who  have  borne  children  and 
those  who  employ  means  to  prevent  con- 
ception, or  to  arrest  gestation,  are  also  fre- 
quent subjects  of  mucopurulent  catarrh. 
The  exciting  causes  are  either  mechanical  in- 
jury to  the  cervix,  or  an  irregular  congestion 
of  the  uterus  without  the  means  nature  pro- 
vides for  the  emptying  of  the  surcharged 
vessels.  The  results  are  the  same,  though  in 
less  degree.  A  heavy  uterus,  endometritis, 
endocervicitis,  glandular  hyperplasia,  infec- 
tion, and  lastly  the  formation  of  pus. 

But  mucopurulent  catarrh  occurs  in  un- 
married women.  The  pathology  is  similar, 
erosion  of  the  cervix  from  which  pus  is  de- 
rived, and  excessive  secretion  of  mucus  by 
the  vaginal  epithelium  and  glands.  Such 
cases  are  not  usual,  but  we  do  find  well  de- 
veloped erosion  of  the  cervix  in  virgins,  as 
we  find  congenital  laceration  of  the  cervix 
from  defective  fusion  of  the  uterine  seg- 
ments.    Mucopurulent  catarrh  in  virgins  is 


OCCUPATIONS  AND  CONDITIONS.  S3 

associated  with  malposition  of  the  uterus, 
most  frequently  retroflexion,  and  with  con- 
gestion of  the  pelvic  organs.  Retroflexion  of 
the  uterus  is  a  potent  factor  in  causing  con- 
gestion and  swelling  of  the  cervical  endo- 
metrium and  the  cervical  glands,  thus 
through  successive  stages  removing  the 
natural  protection  against  invasion  of  the 
cervix  by  micro-organisms. 

Certain  occupations  followed  by  women 
conduce  to  the  same  end.  Among  these, 
standing  long  hours,  as  until  quite  recently 
required  of  shop  girls,  is  most  prolific  in  in- 
ducing pelvic  congestion,  uterine  displace- 
ments and  perverted  function  of  the  genital 
mucosa.  The  fatigues  incident  to  social  life 
in  our  large  cities,  and  its  unnatural  excite- 
ments furnish  their  quota  to  the  local  condi- 
tions that  favor  bacterial  infection  of  the 
vagina  and  uterus.  In  other  words,  the 
vagina  being  naturally  a  self -cleansing  and 
aseptic  canal  becomes  through  unnatural 
conditions  non-resistant  to  infection.  The 
uterus  and  pelvic  organs  also  suffer  from 
similar  unhygienic  conditions,  and  one  of  the 
results  is  gynaecological  catarrh  of  the  mucu- 
purulent  variety. 


54  I,i:uCORRHC^A. 

Mucopurulent  catarrh  is  among  the  most 
common  of  gynsecic  diseases,  but  because 
women,  and  especially  married  women,  are 
accustomed  to  more  or  less  vaginal  dis- 
charge, the  disease  has  frequently  become 
quite  well  established  before  brought  to  the 
specialist's  attention,  and  even  then,  unless  its 
importance  is  almost  unduly  exaggerated,  it 
is  difficult  to  impress  patients  with  the  neces- 
sity for  persistent  and  systematic  treatment. 

The  discharge  of  mucopurulent  catarrh 
consists  of  mucus  containing  pus  cells,  some 
broken  down  epithelial  cells  and  incompletely 
emptied  goblet  cells.  Because  of  the  altera- 
tions that  may  take  place  in  the  secretion 
from  the  glands,  according  to  the  length  of 
time  it  lies  in  the  vagina,  and  also  according 
as  the  reaction  is  acid,  alkaline  or  neutral, 
the  gross  character  of  mucopurulent  catarrh 
will  vary  considerably. 

Typical  mucopurulent  catarrh  is  yellow- 
ish in  appearance,  with  the  predominance  of 
pus  it  assumes  a  creamy  consistence,  and 
when  the  cervical  canal  is  involved  there  will 
be  strings  of  clear,  transparent  mucus  mixed 
with    the    opaque    material.      Occasionally 


TIME  O^  AGGRAVATION.  55 

there  is  a  slight  tinging  with  blood.  This 
calls  for  a  rigid  examination,  aware  as  we 
are  of  its  possible  grave  pathological  signifi- 
cance. Occurring  as  a  feature  of  an  eroded 
cervix  from  which  it  emanates,  it  may  mean 
nothing  more  than  a  temporarily  increased 
local  congestion,  but  the  true  state  of  the 
case  should  be  ascertained,  and  the  source 
and  cause  of  the  bleeding  determined  without 
delay. 

It  is  characteristic  of  a  mucopurulent  dis- 
charge to  harden  upon  exposure  to  the  air; 
we,  therefore,  find  yellow  crusts  on  the  ex- 
ternal parts  where  the  matter  has  been  allow- 
ed to  accumulate.  As  a  rule,  these  crusts  are 
not  difficult  to  remove  and  will  not  be  present 
when  systematic  local  treatment  is  carried 
out. 

Mucopurulent  catarrh  is  generally  aggra- 
vated a  few  days  before  and  a  few  days  fol- 
lowing menstruation,  the  period  of  least  dis- 
charge being  the  mid-month.  It  is  also  in- 
creased during  the  first  months  of  preg- 
nancy— if  present  before  conception — when 
it  becomes  a  most  annoying  symptom.  After 
the  third  month  the  discharge  is  generally 


56  I^KUCORRHG^A. 

reduced  in  quantity  until  just  prior  to  con- 
finement, when  it  is  liable  to  become  quite 
profuse  again.  It  may,  however,  continue 
during  the  entire  period  of  gestation. 

The  reaction  of  mucopurulent  catarrh  is 
always  alkaline,  the  vagina  having  lost  its 
protective  acidity.  When  strongly  alkaline 
the  discharge  is  corrosive  and  will  injure  any 
fabrics  with  which  it  comes  in  contact.  A 
patient's  linen  is  in  this  way  frequently  quite 
destroyed. 

The  clinical  picture  of  gynaecological 
mucopurulent  catarrh  will  not  be  complete 
without  considering  the  constitutional  symp- 
toms. Those  that  accompany  this  form  of 
catarrh  are  varied.  One  of  the  most  com 
mon  is  a  persistent  backache.  This  is  a  dull, 
wearisome  pain  below  the  waist  line.  It  is 
aggravated  by  standing,  but  is  never  wholly 
absent  save  during  menstruation,  vv^hen  there 
may  be  relief. 

Digestion  suffers,  and  the  appetite  is  liable 
to  be  fickle,  almost  to  the  unnatural  cravings 
of  gestation.  Constipation  is  always  pres- 
ent, and  is  due  to  a  torpid  condition  of  the 
rectum.     The  patient  complains  of  a  dull 


occipital  headache,  with  which  she  wakens 
in  the  morning,  continuing  with  more  or  less 
severity  during  the  day.  As  general  nutri- 
tion suffers  the  skin  becomes  dry  and 
ansemic,  and  on  the  face  and  back  acne  may 
develop.  The  patient  is  always  tired,  she 
becomes  exhausted  after  slight  exertion  and 
does  not  readily  recuperate.  This  picture  is 
an  extreme  one,  but  in  varying  degree  be- 
longs to  every  case  of  mucopurulent  catarrh. 

The  cure  of  mucopurulent  catarrh  can  be 
eff'ected  only  with  the  faithful  co-operation 
of  the  patient,  and  after  persistent  treat- 
ment, which  to  be  successful  must  include 
careful  individualization  of  symptoms  and  of 
pathological  conditions.  The  treatment  is 
naturally  divided  into  local  and  constitu- 
tional. 

The  local  treatment  will  be  the  use  of  the 
douche,  the  medicated  tampon,  direct  appli- 
cations to  the  eroded  cervix  and  the  vagina, 
and  cervical  curettage.  A  lacerated  cervix 
must,  of  course,  be  repaired,  for  without 
trachelorrhaphy  the  erosion  cannot  be  cured. 
Any  malposition  of  the  uterus  that  exists 
will  also  be  corrected,  for  until  this  is  done 


58  i,e:ucorrhce:a. 

the  circulation  of  the  pelvis  cannot  be  re- 
stored. As  the  infection  is  from  pus-form- 
ing  cocci,  unless  in  the  beginning,  Boracic 
acid  will  not  control  the  disease.  More  ac- 
tive bactericides  are  necessary. 

I  generally  make  my  selection  from  among 
three  drugs.  Bichloride  of  mercury,  Iodine 
and  Carbolic  acid.  My  routine  practice,  sub- 
ject, however,  to  variations,  is  the  following: 
At  the  first  examination — Cusco's  speculum 
affords  the  best  exposure — the  mucous  mem- 
brane is  thoroughly  cleansed  with  a  solution 
of  Bicarbonate  of  soda,  followed  by  Carbolic 
acid.  For  this  and  for  all  cleansing  of  the 
vagina  I  use  the  selected  medicament  in  the 
form  of  a  spray  with  compressed  air.  The 
force  of  the  spray  easily  reaches  parts  that  a 
douche  cannot  touch.  Bicarbonate  of  soda 
cuts  tenacious  mucus,  and  Carbolic  acid 
possesses  a  soothing  as  well  as  an  antiseptic 
action. 

The  eroded  cervix  is  then  lightly  painted 
with  Carbolic  acid  95  per  cent.,  its  action  be- 
ing antagonized  with  alcohol.  The  Carbolic 
acid  follows  the  sulci  between  the  hyper- 
trophied    glands    and    attacking    necrosed 


USD  OF  TAMPON.  59 

matter  dislodges  it,  to  be  subsequently  mixed 
with  the  discharge.  The  patient  is  directed 
to  take  a  Carbolic  douche  1/60,  each  night 
and  morning,  and  to  return  for  treatment  at 
the  end  of  three  days.  By  that  time  the 
slough  on  the  cervix  caused  by  the  acid  ap- 
plication has  been  cast  off,  and  the  eroded 
surfaces  are  ready  for  further  treatment. 
The  discharge  will  not  be  diminished,  but  it 
will  be  thicker,  and  more  creamy.  The  erod- 
ed surface  will  be  found  bathed  in  pus,  but 
this  is  easily  removed,  and  the  underneath 
structures  appear  more  healthy. 

This  treatment  is  repeated  at  intervals  of 
three  days,  that  is,  two  days  intervene  be- 
tween the  treatments,  for  generally  about 
two  weeks,  or  until  the  first  menstruation. 
If  there  is  much  congestion  of  the  uterus 
with  enlargement  and  swelling  of  the  cer- 
vix, it  may  be  advisable  to  use  a  tampon  sat- 
urated with  boroglyceride,  but  in  the  pres- 
ence of  a  profuse  discharge  from  the  cervix 
I  avoid  even  this  light  obstruction  of  the 
vagina,  seeking  to  promote  drainage  rather 
than  to  retard  it. 

If  the  vaginal  walls  are  relaxed  an  as- 


60  I^EUCORRHC^A. 

tringent  douche  will  replace  the  Carbolic 
acid.  Powdered  Sulphate  of  copper  and 
Alum,  equal  parts,  of  which  half  a  teaspoon- 
ful  is  added  to  two  quarts  of  water,  will 
serve  a  useful  purpose.  As  a  rule,  however, 
in  what  I  consider  the  preliminary  treat- 
ment I  depend  upon  Carbolic  acid  for  both 
douche  and  topical  application  to  the  eroded 
surfaces.  This  drug  has  a  most  beneficial 
effect  upon  the  mucous  membrane  in  the 
early  stages  of  mucopurulent  catarrh,  or 
when  the  case  comes  to  us  from  another  sur- 
geon, and  single-handed  will  usually  prepare 
the  diseased  structures  for  subsequent  and 
more  strictly  curative  treatment. 

Following  Carbolic  acid,  my  chief  reliance 
is  placed  upon  Iodine.  I  use  it  for  spraying 
the  vagina,  and  apply  it  to  the  pus  secreting 
surfaces.  I  prefer  Churchill's  tincture,  for 
in  addition  to  the  counter-irritant  action  of 
Iodine  there  is  the  well  known  softening  ac- 
tion of  Iodide  of  potassium  on  inflammatory 
deposits  and  exudates.  For  the  spray  I  use 
Iodine  in  the  proportion  of  one  drachm  in  a 
pint  of  water,  to  cleanse  the  cervix;  this 
should  always  be  done.     I  paint  the  eroded 


gIvYCE:ridk  o^  iodine:.  61 

surface  with  the  tincture.  As  the  in- 
ternal OS  is  usually  closed,  the  Iodine  may  be 
carried  well  into  the  cervical  canal  with  little 
fear  of  invading  the  body  of  the  uterus. 

At  this  stage  the  vaginal  tampon  will  as- 
sist in  restoring  the  eroded  cervix,  and 
through  its  hygroscopic  action,  glycerine  will 
greatly  relieve  congestion  of  the  pelvic 
structures.  I  still  rely  upon  Iodine.  Gly- 
cerine will  take  up  about  1.90  parts  of  Iodine 
crystals,  and  for  the  purpose  of  medicating 
tampons  I  find  it  convenient  to  keep  a  bottle 
of  glycerine  containing  iodine  crystals  in  my 
office.  After  standing  twenty-four  hours 
the  saturation  is  complete,  and  the  glycerine 
solution  may  be  used  with  definite  knowledge 
of  its  strength.  Half  a  drachm  of  this  solu- 
tion is  added  freshly  to  enough  glycerine  to 
drench  the  tampon,  which  is  then  carried  up 
against  the  cervix. 

This  treatment  must  be  repeated  at  first 
twice  a  week,  later  once  a  week  will  be  suffi- 
cient. Iodine  is  exquisitely  homoeopathic  to 
the  glandular  hyperplasia,  it  is  a  most  effi- 
cient bactericide,  and  has  a  marked  predilec- 
tion for  necrotic  tissue,  inducing  its  separa- 
tion without  injury  to  the  healthy  structures. 


62  i,e:ucorrhc^a. 

In  mucopurulent  catarrh  I  formerly  used 
Ichthyol  tampons,  but  my  results  have  been 
more  satisfactory  from  the  Iodine  treatment, 
and  the  preparation  of  the  crystals  in  gly- 
cerine I  prefer  to  that  made  with  the  tinct- 
ure. 

It  may  become  necessary  to  curette  the 
cervical  endometrium  and  to  remove  the 
glandular  hyperplasia  of  the  os,  and  portio- 
vaginalis,  but  such  a  requirement  will  be  un- 
usual for  mucopurulent  catarrh.  When 
curetting  is  necessary  the  case  has  almost 
certainly  progressed  to  a  more  decided  puru- 
lent form — purulent  catarrh.  Further  refer- 
ence will  be  made  to  the  operative  treatment 
when  discussing  this  variety  of  gynaecologi- 
cal catarrh. 

The  constitutional  treatment  of  muco- 
purulent catarrh  is  a  broad  subject,  for  it 
will  embrace  the  entire  life  history  of  the  pa- 
tient, and  may  necessitate  consulting  a  vast 
number  of  remedies  before  the  similimum  is 
found. 

Every  case  of  mucopurulent  catarrh 
should  be  examined  vaginally,  for  it  goes 
without  saying  that  the  cause  must  be  re- 


CONSTIPATION.  63 

moved,  and  this  can  be  determined  only  by 
assuring  ourselves  of  the  condition  of  the 
pelvic  organs.  The  position  and  size  of  the 
uterus  are  of  the  utmost  importance.  Any 
misplacement  must  be  corrected,  and  if  there 
is  subinvolution  the  treatment  will  be  direct- 
ed to  its  cure.  Any  underlying  dys- 
crasia  will  receive  careful  attention,  faulty 
nutrition  which  is  at  the  bottom  of  non- 
resistance  to  the  invasion  of  micro-organ- 
isms will  be  overcome  by  regulating  the  diet 
and  promoting  assimilation. 

There  is  almost  always  obstinate  constipa- 
tion, a  condition  of  torpor  of  the  lower 
bowels  caused,  as  is  frequently  the  case  with 
women,  by  .neglect  to  respond  to  the  demand 
to  stool.  It  will  be  necessary  to  empty  the 
rectum,  after  which  diet,  exercise,  occasional 
Cascara  and  Maltine,  A.  S.  B.  tablets,  or 
Merc,  dulcis  if  the  liver  seems  inactive,  or 
Alumina  when  the  rectum  has  lost  its  power, 
may  be  required.  A  course  of  Rubinat  con- 
dal,  or  Hunyadi  water,  or  the  phosphate  of 
soda,  as  already  suggested,  may  be  neces- 
sar}^  By  this  I  mean,  giving  a  small  dose  of 
one  of  these  salines  daily  until  the  intestinal 


64  i,]E:ucoRRHaeA. 

canal  is  empty.  One  tablespoonful  of  the 
cathartic  in  a  glass  of  warm  water  before 
breakfast,  will,  unless  in  very  chronic  cases, 
be  all  that  is  required.  No  cathartic  should 
be  continued  too  long,  or  until  the  habit  of  its 
use  is  established.  Constipation  is  one  of  the 
most  obstinate  gynaecological  complications 
with  which  we  have  to  deal,  and  may  tax 
every  resource  within  our  knowledge  before 
it  is  cured,  but  of  one  thing  we  may  be  cer- 
tain, a  pelvic  pathology  that  has  to  do  with 
portal  congestion  cannot  be  removed  as  long 
as  this  lasts.  Not  only  does  the  impaction, 
for  such  it  becomes,  interfere  with  circula- 
tion through  the  pelvic  vessels,  but  there  is  in 
addition  an  actual  toxaemia  induced  by  ab- 
sorption from  the  effete  matter  that  is  re- 
tained in  the  intestines.  Much  of  the 
languor  and  exhaustion  attending  these 
cases  are  undoubtedly  due  to  this  cause.  Es- 
tablishing a  regular  daily  habit  of  going  to 
stool,  even  in  the  absence  of  desire,  will 
frequently  accomplish  a  great  deal  towards 
overcoming  intestinal  inaction,  and  will  in- 
duce an  onward  movement  of  the  faecal  mass. 
Constipation    is    not    as    prevalent    among 


hygiene:.  65 

women  in  the  more  humble  walks  of  life, 
save  those  employed  in  shops  and  factories, 
as  it  is  among  the  well-to-do  or  the  idle  rich. 
A  large  proportion  of  shop  women  suffer 
from  catarrh,  usually  mucopurulent,  and 
they  are  almost  always  constipated.  The 
problem  of  treatment  and  cure  in  these  cases 
of  gynaecological  catarrh  is  well-night  insup- 
erable. Their  very  circumstances  relegate 
them  to  dispensary  care,  or  to  dispensary 
physicians  who  will  attend  them  in  the  even- 
ing. This  is  the  only  time  they  have  for 
recreation,  and,  apart  from  the  actual  cost 
entailed,  they  cannot  be  impressed  with  the 
relative  importance  of  being  cured  of  their 
catarrh.  As  a  rule,  treatment  will  consist 
in  directing  domiciliary  douches,  not  always 
taken  with  antiseptic  precautions,  and  hy- 
gienic prescriptions,  regular  hours,  plain 
food,  and  attention  to  regular  evacuations 
of  the  bowels. 

With  the  idle  rich,  whose  life  is  a  round 
of  pernicious  enjoyment,  the  problem  of 
treatment  is  only  a  little  less  difficult.  They 
will  be  treated— -according  to  their  own 
fancy — and  they  will  take  medicine,  but 
6 


66  I,KUCORRH(KA. 

their  irregular  hours,  rich  and  highly  sea- 
soned food;  their  immoderate  use  of  sweets, 
their  increasing  use  of  alcohol,  without  the 
advantage  that  men  have  of  out  of  door  ex- 
ercise to  somewhat  counteract  its  baneful 
effects,  all  tend  to  congest  the  liver,  and 
induce  constipation.  Their  entire  hygiene 
must  be  corrected  if  they  would  be  cured. 
Early  rising,  early  retiring.  Late  suppers 
must  be  prohibited,  sweets  save  in  modera- 
tion forbidden.  Tea  and  coffee,  sparingly 
taken,  I  do  not  object  to  unless  there  is  some 
counterindication  for  their  use.  Daily  ex- 
ercise unless  the  condition  of  the  pelvic 
organs  forbids,  and  regular  attention  to  the 
bowel  function.  Shortly  after  breakfast  is 
the  best  time  to  cultivate  this  habit,  and 
nothing  should  interfere  with  the  hour  fixed 
for  going  to  stool. 

The  intelligent  well  to  do  patients  furnish 
the  most  promising  subjects  for  treatment. 
They  value  health  more  than  amusement, 
and  will  be  willing  to  give  up  the  latter  with 
the  prospect  of  obtaining  the  former.  The 
principles  underlying  all  hygienic  directions 
are,  to  exclude  as  much  as  possible  luxuries 


sEjxuAi,  hygie:ne:.  67 

that  overbuirden  the  eliminating  organs,  and 
store  up  in  the  system  the  effete  materials  of 
metabolism,  and  to  inculcate,  the  ideas  of 
regular  living. 

The  sexual  hygiene  of  women  may  have  to 
do  with  constitutional  conditions  that  predis- 
pose to  gynaecological  catarrh,  and  with  the 
local  conditions  that  make  for  its  continu- 
ance. Excessive  indulgence,  or  unsatisfied 
desire — more  frequent  in  women  than  is 
generally  acknowledged — act  equally  in 
causing  congestion  of  the  lower  segment  of 
the  uterus — it  will  be  remembered  that  this 
is  really  an  erectile  organ — with  consequent 
endometritis.  The  various  means  taken  to 
prevent  conception,  both  passive  and  active, 
undermine  the  constitution  of  women,  and 
predispose  to  the  below  par  state  that  is  so 
frequently  associated  with  mucopurulent 
catarrh  of  the  genital  canal.  I  do  not  wish 
to  convey  the  impression  that  mucopurulent 
catarrh  is  the  chief  symptom  of  such  a  con- 
stitutional condition,  but  I  do  assert  that  it 
is  one  of  the  symptoms,  and  is  not  conceiv- 
ably present  under  conditions  of  well  being. 


68  i,eucorrhce:a. 

While  it  may  be  necessary  to  consult  the 
entire  materia  medica  to  find  the  similimxum 
for  a  given  case  of  mucopurulent  catarrh,  a 
few  remedies  have  proved  of  value.  For 
fuller  indications  reference  may  be  made  to 
Part  IV  of  this  Treatise. 

Pulsatilla,  Sepia,  Aletris,  Hydrastis,  the 
latter  from  its  certain  action  on  the  uterine 
musculature  makes  it  especially  valuable 
when  there  is  subinvolution;  the  Potash 
salts,  especially  Bichromate  and  Chlorate. 
Iodine  is  of  a  very  wide  application,  inter- 
nally as  well  as  locally,  especially  when  there 
is  an  underlying  dyscrasia.  It  is  especially 
applicable  to  delicate  women  who  are  easily 
exhausted,  brunettes  with  dark,  lifeless  look- 
ing skin.  All  the  discharges  are  corrosive, 
and  there  is  a  concomitant  marked  conges- 
tion of  the  ovaries.  Kreosote  will  be  indi- 
cated when  the  mucopurulent  discharge  is 
offensive,  and  very  irritating,  causing  swell- 
ing, itching  and  excoriation  of  the  parts  with 
v/hich  it  comes  in  contact.  The  portio-vagi- 
nalis  is  purple  and  indurated,  and  the  en- 
larged glandular  masses  form  ridges  that 
project  beyond  the  surface.    Sepia  is  of  fre- 


the:  tissue:  rkmedie:s.  69 

quent  use  in  this  form  of  catarrh,  especially 
when  there  is  a  general  relaxation  of  the 
pelvic  structures.  The  uterine  supports  have 
given  away,  the  uterus  is  heavy  and  prolaps- 
ed, the  condition  being  one  of  atony,  fre- 
quently following  confinement.  The  pa- 
tients are  feeble  and  debilitated,  with  dark 
complexion,  fine  skin,  and  extremely  sensa- 
tive  to  impressions.  The  indications  for 
Sepia  are  more  upon  constitutional  than  local 
symptoms.  The  general  condition  of  the  pa- 
tient greatly  influences  the  choice  of  this 
remedy. 

But  while  there  are  many  old  and  tried 
remedies  that  have  done,  and  will  continue  to 
do;  yoeman's  service,  I  have  come  to  place 
much  reliance  on  the  tissue  remedies  for  the 
treatment  of  mucopurulent  gynaecological 
catarrh,  and  frequently  make  my  selection 
from  among  them  during  the  course  of  treat- 
ment. They  are  indicated  by  the  pathology, 
the  constitution,  and  the  subjective  as  well 
as  the  objective  symptoms,  and  more  fre- 
quently, I  think,  than  any  other  class  of  rem- 
edies, cover  the  complete  picture  of  the  dis- 
ease. 


70  LKUCORRHC^A. 

The  lime  salts  stand  out  prominently. 
Calcarea  phosphorica  will  be  useful  as  a 
general  tonic  in  women  who  have  borne  chil- 
dren too  rapidly,  and,  who,  in  consequence, 
suffer  from  exhausted  vitality.  It  is  also  use- 
ful in  senile  conditions,  especially  the  vaginal 
pruritus  of  old  women.  Calcarea  sulphurica 
is  possibly  more  useful  in  purulent  catarrh 
than  in  the  mucopurulent  variety,  but  its  ac- 
tion upon  glandular  structures  and  mucous 
membranes  is  so  marked  that  it  may  be  call- 
ed for  here.  When  the  discharge  contains 
lumps  of  pus  mixed  with  mucus,  I  always 
think  of  Cal.  sulph.  Kali  phosphoricum  ren- 
ders valuable  aid  in  the  treatment  of  muco- 
purulent catarrh.  Not,  I  believe,  because  of 
its  direct  action  upon  the  structures  involved 
in  the  morbid  process,  but  as  a  general  nerve 
restorer.  If  the  catarrh  has  existed  any 
length  of  time  the  patient  suffers  from  nerve 
exhaustion,  and  will  become  before  long  a 
subject  of  some  degree  of  neurasthenia.  I 
know  of  no  remedy  that  fits  these  cases  as 
perfectly  as  Kali  phos.  It  is  the  great  nour- 
isher  of  nerves,  and,  by  accomplishing  this, 
aids  assimilation  and  the  reconstruction  of 


ME:TH0D  01^  USING  KAU  PHOS.  71 

tissues.  With  this  object  in  view,  I  fre- 
quently give  Kali  phos.  in  hot  water  before 
eating,  at  the  same  time  that  I  exhibit  the 
remedy  that  more  closely  suits  the  local 
pathology,  and  its  attendant  symptoms. 
I  rarely  now  carry  through  a  case  of 
chronic  mucopurulent  catarrh,  or  for  that 
matter  any  long-lasting  gynaecological  case 
that  has  induced  exhaustion,  without  the 
aid  of  Kali  phos.  Kali  sulphuricum  exerts 
such  a  powerful  action  upon  the  epithelial 
covering  of  mucous  membranes  that  we 
naturally  consider  this  salt  in  relation  to 
catarrh.  I  frequently  use  it  when  the 
discharge  contains  large  quantities  of  epi- 
thelial cells — Kali  sulph.  causes  this  desqua- 
mation— shown  clinically  by  its  creamy  ap- 
pearance. The  mucous  secretion  is  crowded 
with  cylindrical  epithelial  cells  that  have 
been  cast  off  from  the  mucosa.  Or  there 
may  be  complete  desquamation  of  the  vagina, 
the  epithelium  appearing  in  shreds.  Kali 
sulph.  also  interferes  with  the  lymphatic  sys- 
tem, causing  a  diminution  of  the  lymph 
supply.  The  catarrhal  discharge  then  be- 
comes sticky  and  stringy.     A  slimy,  yellow- 


72  i,]e:ucorrhce:a. 

ish  catarrh,  containing  masses  of  epithelial 
cells  and  lumps  of  pus,  is  strongly  suggestive 
of  Kali  sulphuricum. 

C.     PuruIvKnt  Catart.h. 

Unless  the  result  of  mechanical  denuda- 
tion of  the  genital  canal  and  acute  pyogenic 
infection,  purulent  catarrh  is  frequently  a 
continuation  of  the  mucopurulent  variety. 
More  tissues  are  involved,  and  the  formation 
of  pus  quite  outweighs  and  takes  the  place 
of  the  normal  mucous  secretion.  The  dis- 
charge is  pus,  the  mucous  element  constitut- 
ing only  an  insignificant  part  of  its  volume. 

We  will  at  the  outset  avoid  the  mistake  of 
regarding  any  flow  of  pus  from  the  genital 
canal  as  a  purulent  catarrh.  A  pyosalpinx 
that  discharges  through  the  uterus,  a  pelvic 
abscess  that  empties  itself  through  the 
vagina,  or  a  purulent  uterus,  cannot  be  class- 
ed as  catarrh,  though  the  discharge  contains 
pus.  Any  one  or  all  of  these  may  coexist 
with  purulent  catarrh,  and  will,  then,  as 
the  more  serious  pathology,  demand  spe- 
cial treatment,  but,  as  already  pointed  out, 
catarrh  does  not  embrace  such  a  pathology. 


VUI.VITIS.  Th 

Gynaecological  catarrh  is  essentially  a  dis- 
ease of  the  mucous  membranes  lining  the 
genital  canal,  and  its  various  phases  arise 
from  the  manner  in  which  these  tissues  are 
affected,  and  the  extent  of  their  involvement. 
Much  that  has  been  said  of  mucopurulent  ca- 
tarrh may  with  equal  propriety  be  told  of 
purulent  catarrh,  the  graduations  between 
the  two  varieties  are  slow  and  difficult  to 
distinguish  clinically.  But  when  fully  de- 
veloped, purulent  catarrh  makes  a  picture 
that  admits  of  no  doubt  in  diagnosis. 

The  entire  genital  mucosa  is  usually  in- 
volved in  the  morbid  process,  even  the  lining 
of  the  Fallopian  tubes  may  participate. 
While  functionating  goblet  cells  may  exist, 
their  physiological  role  is  imperfectly  per- 
formed, and  is  entirely  dominated  by  the 
process  that  makes  for  an  excessive  desqua- 
mation of  the  epithelial  layer,  and  the  ex- 
travasation of  pus  degenerated  leucocytes. 
The  vulva,  if  not  a  part  of  the  primary  in- 
fection, soon  becomes  involved.  Vulvitis  is 
present  with  an  increased  secretion  from 
Bartholin's  glands,  and  desquamation  of  epi- 
thelium.    The  vaginal  mucous  membrane  is 


74  i,Eucorrhce:a. 

congested,  swollen  and  velvety.  In  places  it 
is  entirely  denuded  of  its  epithelial  covering, 
these  spots  appearing  a  deeper  red  than  the 
surrounding  tissues.  Examination  shows 
them  to  be  the  principal  points  from  which 
the  pus  cells  are  thrown  off. 

There  is  a  form  of  purulent  catarrh  al- 
most confined  to  a  gonorrhoeal  infection,  or 
to  the  puerperium,  that  is  characterized  by 
the  development  of  granules  situated  in  the 
mucous  membrane.  These  are  best  demon- 
strated by  the  examining  finger  to  which 
they  feel  like  hard  bodies  the  size  of  small 
seeds  that  are  freely  movable.  I  have  found 
such  granules,  though  not  in  sufficient  num- 
bers to  constitute  a  distinct  pathological  en- 
tity, unconnected  with  gestation,  and  where 
the  possibility  of  a  gonorrhoeal  infection 
could  not  be  entertained.  I,  therefore,  can- 
not consider  them  as  characteristic  of  either 
of  these  states.  Their  presence  does  not 
seem  to  be  connected  with  the  formation  of 
pus,  but  is  more  probably  an  expression 
of  a  mixed  infection. 

As  in  mucopurulent  catarrh,  the  portio- 
vaginalis  is  actively  involved  in  the  morbid 


ENDOMETRITIS.  75 

process.  There  is  always  an  erosion  of  the 
cervix,  which,  from  the  intensity  of  the  pro- 
cess, may  extend  well  out  towards  the  fornix 
and  break  down  into  an  actual  ulceration 
with  loss  of  substance. 

Nor  does  the  morbid  process  stop  at  the 
internal  os,  for  as  the  cervical  canal  shares  in 
the  erosion  the  cavity  of  the  uterus  is  early 
invaded.  The  endometrium  is  inflamed — 
purulent  endometritis — and  swollen.  Its 
glands  in  consequence  are  excited  to  a  path- 
ological activity,  and  pus  corpuscles  are  form- 
ed in  abundance  to  mingle  with  the  unhealthy 
mucous  secretion.  The  quantity  of  discharge 
is  sometimes  a  matter  of  astonishment  lead- 
ing to  the  suspicion  of  some  pus  cavity  ex- 
isting connected  with  the  body  of  the  uterus 
through  which  it  seems  to  discharge. 

The  endometritis  that  forms  a  part  of  pur- 
ulent catarrh  runs  a  more  or  less  chronic 
course,  similar  to  the  process  in  the  vagina. 
There  is  almost  always  a  laceration  of  the 
cervix,  and  a  wide  open  cervical  canal 
through  which  the  infection  takes  place,  for 
it  will  be  remembered  that  the  healthy  uterus 
contains  no  micro-organisms,  and  will  re- 


76  i.Eucorrhoe:a. 

main  free  from  them  as  long  as  the  cervical 
canal  continues  its  sentinel  duty. 

In  some  cases  desquamation  of  the  epi- 
thelial covering  of  the  mucosa  takes  place  so 
rapidly  that  the  vessels  are  not  sufficiently 
protected,  and  there  is  an  oozing  of  blood 
that  tinges  the  discharge  brown.  At  other 
times  the  discharge  may  become  green  in 
color,  depending  upon  decomposition  that 
has  taken  place,  and  possibly  the  presence  of 
some  special  micro-organism,  for  purulent 
catarrh  is  always  a  mixed  infection. 

There  is  a  form  of  purulent  catarrh  occur- 
ring in  old  women,  associated,  if  not  wholly 
dependent,  upon  "senile  endometritis," — 
senile  purulent  catarrh.  The  condition  is  one 
of  senile  degeneration  in  which  connective 
tissue  is  in  excess  of  gland  tissue,  the  mucous 
membrane  being  replaced  by  fibrous  tissue. 
The  discharge  is  often  bloody,  and  offensive 
from  decomposition  of  the  contents  of  the 
uterus.  In  such  cases  the  process  of  atrophy 
that  attacks  the  uterus  has  the  effect  of  clos- 
ing the  cervical  canal  for  purposes  of  drain- 
age, which  accounts  for  the  decomposition  of 
the  retained  discharge. 


The   vagina  does   not   share   actively   in 
these  senile  changes,  though  there  may  be  a 
vaginitis  which  I  am  incHned  to  beheve  is  in 
some  instances  an  entirely  separate  disease. 
When  the  vagina  is  involved  the  canal  feels 
like   a    fibrous   cone   very   much    narrowed 
above,  at  the  apex  of  which  is  situated  the 
cervix  uteri.    There  are  sometimes  bands  of 
contracting  scar  tissue  encircling  the  vagina, 
or  a  distinct  diaphragm  may  exist  through 
which  the  finger  must  pass  to  reach  the  os. 
The  vaginal  walls  are  smooth  in  places,  in 
others  there  are  red  elevated  spots.  The  dis- 
charge is  not  profuse,  but  is  characteristic- 
ally purulent.     Care  must  be  exercised  to 
distinguish    this    senile    degeneration    from 
cancer  of  the  uterus  and  vagina. 

As  the  Fallopian  tubes  are  in  health  also 
free  from  micro-organisms,  catarrh  of  these 
ducts  will  be  an  extension  from  the  uterus. 
Salpingitis  and  pyosalpinx  may  thus  become 
parts  of  the  clinical  history  of  gynaecological 
purulent  catarrh,  but  a  pus  tube  is  a  pa- 
thological as  well  as  a  clinical  entity,  and  is 
only  referred  to  here  as  a  possible  complica- 
tion of  purulent  catarrh.     The  same  is  true 


78  I^EUCORRHOeA. 

of  tuberculosis  of  the  Fallopian  tubes  and  of 
the  lower  parts  of  the  genital  canal.  The 
chief  clinical  symptom  may  be  that  of  puru- 
lent catarrh,  but  an  examination  of  the  dis- 
charge will  establish  or  break  down  the 
diagnosis  of  tubercular  infection. 

Purulent  gynaecological  catarrh  is  a  dis- 
ease of  adult  life;  it  occurs  most  frequently 
in  married  w^omen,  and  is  almost  invariably 
associated  with  a  lacerated  cervix,  which  we 
must  look  upon  as  the  door  through  which 
infection  takes  place.  The  majority  of  cases 
originate  in  this  manner,  the  vagina  and 
uterus  being  secondarily  invaded.  When  the 
uterus  is  the  primary  focus  of  disease,  the 
endometritis  of  purulent  catarrh  has  passed 
from  the  stage  of  acute  infection,  puerperal, 
to  the  chronic  form,  which,  because  of  the 
deep-seated  pathology  of  puerperal  infec- 
tion, will  be  found  especially  rebellious  to 
treatment. 

Purulent  catarrh  may  follow  infection 
from  the  use  of  examining  instruments,  or 
even  from  the  examining  finger.  Simple  ca- 
tarrh, or  mucopurulent  catarrh,  being  pres- 
ent,   the    introduction    through    whatever 


kxanthe:matous  dise:ase:s.         79 

agency  of  more  active  pyogenic  cocci  is  suffi- 
cient to  cause  a  predominance  of  pus,  and 
give  a  purulent  character  to  the  discharge. 
It  is  not  infrequently  a  result  of  genital 
tuberculosis,  and  may  be  a  sequela  of  ex- 
anthematous  diseases. 

The  clinical  course  of  purulent  catarrh 
tends  to  a  permanent  tissue  degeneration  and 
progressive  structural  involvement.  There 
is  no  likelihood  of  self-limitation.  The  posi- 
tive and  ever-present  danger  of  infection  of 
the  peritoneum  by  way  of  the  Fallopian 
tubes  confronts  us  when  the  disease  is  well 
established.  The  physiological  current  of 
the  ova  ducts  is  towards  the  uterus,  but  dis- 
ease so  alters  the  ciliary  epithelium  that  not 
only  may  the  morbid  secretion  break  through 
the  fimbria,  but  the  uterus  by  these  chan- 
nels may  discharge  its  contents  into  the  ab- 
dominal cavity.  Nature,  however,  frequent- 
ly comes  to  our  aid  in  this  grave  condition, 
for  her  tendency  is  to  close  the  distal  open- 
ings of  the  tubes  by  inflammatory  exudate, 
in  advance  of  the  formation  of  pus. 

So  constantly  is  the  necessity  for  plastic 
reparative  work  on  the  uterine  cervix  a  part 


80  I,E:UCORRHCeA. 

of  the  cure  of  gynaecological  catarrh  that 
this  disease  may  with  propriety  be  classed 
among  surgical  affections,  and  we  may  be 
sure  that  any  successful  treatment  must  in- 
clude some  operative  procedure. 

Each  case  wall  be  individualized,  but  cer- 
tain general  rules  apply  to  all,  and  their  sys- 
tematic observance  will  greatly  aid  the  treat- 
ment. The  first  indication  is  to  render  the 
genital  canal  as  nearly  aseptic  as  possible, 
and  to  restore  the  field  of  operation  to  a  state 
fitted  for  surgical  manipulation.  In  other 
w^ords,  the  vagina  must  be  cleansed,  its  func- 
tion of  pus  formation  controlled,  and  the 
eroded  surfaces  of  the  lacerated  cervix 
brought  into  a  condition  in  which  healing 
wnll  follow  an  operation.  This  will  require 
time  and  much  patience,  and  we  will  prob- 
ably be  obliged  to  ring  the  changes  on  a 
great  variety  of  douches,  and  applications  to 
the  hyperplastic  cervical  tissues. 

As  in  mucopurulent  catarrh,  I  am  very 
partial  to  the  local  use  of  Iodine.  It  not  only 
controls  suppuration,  but  it  assists  in  getting 
rid  of  the  necrotic  tissues  that  so  frequently 
form  in  the  vagina  and  on  the  portio-vagi- 


PRURITUS.  81 

nalis.  Bichloride  of  mercury  I  do  not  use  as 
much  as  formerly.  If  of  sufficient  strength 
to  be  an  efficient  bactericide  it  is  corrosive, 
increasing  vaginitis  and  sometimes  setting 
up  a  troublesome  dermatitis.  Creoline,  one 
drachm  in  two  quarts  of  water,  will  act  well 
in  the  presence  of  much  swelling,  oedema  and 
cellular  infiltration  especially  suggest  its  use. 
Hydrastis,  fluid  extract,  is  useful  when  the 
mucous  membrane  is  highly  congested,  bleed- 
ing easily  when  touched,  and  when  the  puru- 
lent discharge  contains  streaks  of  blood,  in- 
dicating the  involvement  of  the  walls  of  the 
capillary  vessels.  The  same  condition  is  ob- 
served on  the  portio-vaginalis  in  even  more 
pronounced  form,  distended  vessels  being 
plainly  visible  through  the  thin  epithelial 
layer.  In  such  conditions  Hydrastis  will  not 
fail  to  bring  about  improvement.  Extract  of 
Witch  hazel  and  Hydrastis,  equal  parts,  of 
which  one  drachm  is  dissolved  in  one  quart 
of  water,  is  a  favorite  douche  in  my  practice. 
Pruritus,  especially  in  women  past  the 
menopause,  is  sometimes  a  most  trying  con- 
comitant of  purulent  catarrh.  It  may  be- 
come so  intense  as  to  demand  treatment  in- 


82  I.i:UCORRHCEA. 

stituted  exclusively  for  its  relief,  without  re- 
gard to  the  aseptic  requirements  of  the  case. 
Sedative  douches  are  indicated  before  all 
others.  A  saturated  solution  of  Boracic 
acid,  or  a  solution  of  Liq.  plumbi  acet.,  one- 
half  drachm  in  a  pint  of  water,  will  frequent- 
ly give  relief,  and  enable  us  to  use  more 
strictly  aseptic  douches.  When  the  itching 
has  been  intense  I  have  obtained  benefit  from 
the  application  of  lint  saturated  with : 

?.     Acid  hydrocyan.  dil ^ii. 

Plumbi  acetat scruple  ii. 

Glycerine    §ii. 

M. 

Another  useful  douche  when  pruritus  is  a 
marked  symptom  is  Thuja  tincture,  one 
drachm  in  one  quart  of  water.  The  relief 
following  the  use  of  this  douche  is  sometimes 
very  prompt  and  permanent. 

At  the  same  time  we  treat  the  vagina  we 
must  prepare  the  os  and  portio-vaginalis  for 
operation.  Not  much  can  be  done  in  the 
preparation  of  the  cavity  of  the  uterus  for 
curetting,  for  any  intrauterine  treatment  will 
require  a  widely  open  cervical  canal,  insuring 


PREPARATION  01^  CIjRVIX  1?0R  CURKTTING.  83 

drainage  of  the  cavity.  To  dilate  the  canal 
is  in  itself  an  operation,  and  usually  forms 
the  first  step  of  currettage. 

In  preparing  the  cervix  for  operation  I  use 
Carbolic  acid,  Churchill's  tincture;  or 
Chromic  acid,  ten  grains  in  one  ounce  of 
water,  to  destroy  hyperplastic  glands;  or 
sometimes  Acetic  acid,  one  ounce,  containing 
Carbolic  acid,  twenty  drops;  or  Nitrate  of 
silver,  ten  grains,  water,  one  ounce.  But 
Iodine  still  remains  the  most  generally  use- 
ful application.  Its  persistent  use  will  more 
quickly  condition  the  parts  for  operation 
than  any  other  drug  with  which  I  am 
familiar. 

The  above  mentioned  combination  of 
Acetic  acid  and  Carbolic  acid  will  be  of  as- 
sistance when  the  hypersemic,  tensely 
swollen  portio-vaginalis  and  os  uteri  are 
smooth  and  glassy,  apparently  covered  with 
a  shining  film.  In  making  this  application 
care  must  be  taken  to  avoid  contact  with 
healthy  structures.  This  can  be  prevented 
by  holding  pledgets  of  cotton  soaked  with 
the  solution  against  the  os  for  a  few  minutes, 
the  treatment  being  made  through  a  glass — 
Ferguson's  speculum. 


84  IvEUCORRHCBA. 

I  do  not  like  dusting  powders  for  these 
cases.  Our  object  is  to  promote  drainage  of 
the  surcharged  tissues,  and  powders,  with 
possibly  the  exception  of  Calomel,  which  I 
occasionally  use  when  there  is  well  marked 
ulceration  with  loss  of  substance,  dry  the 
parts  and  defeat  this  purpose. 

The  use  of  medicated  tampons  is  indis- 
pensable, and  when  properly  made  and  plac- 
ed will  not  seriously  interfere  with  drainage 
from  the  uteurs. 

First,  as  to  the  making.  As  commonly 
constructed,  the  vaginal  tampon  cannot  ac- 
complish all  that  it  should,  for  after  it  has 
been  in  the  vagina  long  enough  to  become 
saturated  with  discharge,  it  is  converted  into 
a  shapeless  mass  that  presses  unduly  upon 
any  structures  against  which  it  may  lie.  A 
vaginal  tampon  should  above  all  qualities 
possess  elasticity,  and  be  so  fashioned  as  to 
readily  adapt  itself  to  the  conformation  of 
the  upper  part  of  the  vagina.  This  elastic 
quality  is  scarcely  second  to  that  of  holding 
the  medication,  for  it  alone,  without  drug 
saturation,  is  of  conspicuous  assistance  in  re- 
ducing an  overweight  uterus,  and  in  reliev- 


VAGINAI,  TAMPON.  85 

ing  pelvic  congestion  by  virtue  of  holding  up 
the  heavy  and  prolapsed  organs. 

My  directions  for  making  a  vaginal  tam- 
pon are  the  following:  A  thin  piece  of  ab- 
sorbent cotton,  about  four  inches  wide  and 
six  inches  long,  is  pulled  from  the  roll.  It 
should  not  be  cut,  for  this  leaves  straight 
edges  that  do  not  blend  with  the  body  of  the 
tampon,  but  should  be  pulled  away  from  the 
roll.  Near  one  end  is  placed  a  small  quantity 
of  sterile  wool,  picked  apart.  On  the  prepa- 
ration of  this  depends  the  elasticity  of  the 
tampon.  The  wool  should  be  made  light  and 
fluffy.  The  edges  of  the  cotton  cover  are 
then  turned  over  from  side  to  side,  and  the 
wool  rolled  in  the  cotton.  An  elastic  cylinder 
is  thus  formed  entirely  covered  with  cotton, 
which  material  alone  should  come  in  contact 
with  the  vaginal  mucosa.  A  slip  knot  made 
of  a  double  thread  of  darning  cotton  is  then 
thrown  around  one  end  of  the  tampon,  the 
distal  end  when  introduced  into  the  vagina. 
The  size  of  the  tampon  will  be  adapted  to  in- 
dividual requirements,  but  the  principle  of 
construction  will  be  the  same,  insuring  elas- 
ticity, and  a  body  covered  with  cotton  in  such 


86  I,E:UCORRHCeA. 

manner  as  to  prevent  the  irritating  wool 
from  touching  the  vaginal  mucous  mem- 
brane. 

I  usually  select  my  tampon  medicament 
from  among  three,  always  using  glycerine  as 
the  menstrum.  Boroglyceride,  Iodine  and 
Icthyol,  but  others  may  be  indicated.  Hy- 
drastis, when  there  is  a  tendency  to  capillary 
erosion;  Sanguinaria,  half  a  drachm  of  the 
powder  in  one  ounce  of  glycerine,  when  the 
eroded  surface  is  very  vascular  and  bleeds 
easily  if  touched.  Balsam  of  Peru  when  sup- 
puration is  excessive  from  an  ulcerated  sur- 
face, and  the  cervical  endometrium  protrudes 
from  the  inner  os,  but  I  use  these,  and  pos- 
sibly others  as  intercurrent  remedies,  and 
rely  chiefly  upon  the  first  two  mentioned. 
Boroglyceride  will  always  prove  a  sedative, 
and  when  the  case  requires  soothing  applica- 
tions will  be  indicated.  I,  however,  generally 
depend  upon  Iodine  prepared  in  glycerine,  as 
I  have  already  suggested,  for  I  find  it  accom- 
plishes all  that  can  be  accomplished  in  pre- 
paring for  an  operation.  In  introducing  the 
tampon  care  should  be  taken  to  place  it 
against  the  eroded  surface  and  not  in  the 
fornix,  where  it  is  useless. 


IRRIGATION  O^  UTERUS.  ^7 

As  a  part  of  the  preliminary  treatment  it 
is  well  to  irrigate  the  cavity  of  the  uterus  if 
the  OS  is  well  open,  but  I  am  chary  about  do- 
ing this,  knowing  how  readily  in  diseased 
conditions  of  the  endometrium,  and  of  the 
mucosa  of  the  Fallopian  tubes,  fluids  may 
pass  into  the  abdominal  cavity.  For  an  in- 
trauterine douche  I  use  a  weak  solution  of 
Iodine,  one  drachm  in  a  quart  of  sterile 
water. 

As  long  as  the  purulent  element  continues 
in  the  discharge,  it  will  be  impossible  to  ob- 
tain satisfactory  results  from  an  operation 
on  the  cervix,  nor  can  we  safely  curette  any 
part  of  the  uterus.  But  as  soon  as  this  is 
controlled  and  the  catarrh  returns  to  the 
mucous  variety,  repair  of  the  cervix  and 
thorough  removal  of  the  diseased  endo- 
metrium must  be  undertaken,  otherwise  the 
catarrh  cannot  be  cured. 

Curettage  and  trachelorrhaphy  have  be- 
come such  a  routine  procedure  that  there  re- 
mains little  to  say  in  the  matter  of  operative 
technique.  Especially  in  country  practice,  al- 
most every  physician  feels  himself  competent 
to  curette  a  uterus,  and  repair  a  lacerated 


88  i.eucorrhci:a. 

cervix.  The  circumstance  of  remoteness 
justifies  them  in  their  practice,  but  there  is  no 
doubt  that  these  operations  are  sometimes 
followed  by  disastrous  results,  and  are  not 
infrequently  absolute  failures.  The  disas- 
trous results  arise  from  imperfect  asepsis, 
the  failure  to  accomplish  repair  from  lack  of 
thoroughness  in  operative  technique.  The 
avenues  of  pelvic  infection  are  especially  by 
way  of  the  lymphatics  of  the  cervix,  and  the 
uterus,  and  inattention  to  the  smallest  de- 
tails of  preparation,  or  work,  introduce  so 
many  elements  of  danger.  The  slow  and 
imperfect  convalescence  that  occasionally 
follows  trifling  gynaecological  operations, 
can  unquestionably  be  traced  to  some  variety 
of  infection  introduced  with  the  operatioii 
Not  all  pathologic  micro-organisms  are  pyo- 
genic, but  all  when  favorably  placed  live 
their  life  cycle,  in  doing  which  they  either 
draw  from  or  contribute  to  the  system  of 
their  host.  Such  withdrawing  or  giving 
may  be  equally  effective  in  disturbing  meta- 
bolism, in  interfering  with  local  repair,  or 
with  the  restoration  to  health. 

The  operative  technique  for  curetting  the 


technique:  of  curkttagi:.  89 

uterus  and  repairing  a  lacerated  cervix  is 
simple,  as  all  surgery  should  be.  After  irri- 
gating the  vagina  with  Bichloride  of  mer- 
cury, followed  by  normal  salt  solution,  I 
swab  the  exposed  mucosa  with  acidulated  al- 
cohol— Acetic  acid  one  drachm.  Alcohol  one 
ounce.  Acetic  acid  increases  the  bactericidal 
properties  of  alcohol,  and  hardens  the  tissues 
included  in  the  operative  field.  Thorough 
stretching  of  the  cervical  canal,  without 
trauma,  is  necessary  before  curetting.  This 
part  of  the  operation  should  be  done  slowly, 
and  if  the  dilator  used  has  bilateral  blades 
these  must  be  brought  successively  in  con- 
tact with  every  part  of  the  canal  until  it  is 
large  enough  to  admit  with  ease  the  largest 
curette.  Only  a  dull  curette  should  be 
used  to  remove  the  endometrium  of  purulent 
catarrh;  a  sharp  instrument  is  no  more 
effective  in  its  work,  and  possesses  the  posi- 
tive danger  of  opening  channels  for  infec- 
tion. 

Any  plan  of  procedure  that  insures  cover- 
ing the  entire  interior  of  the  uterus  with  the 
curette  may  be  adopted.  Especialy  is  it  nec- 
essary to  go  well  up  into  the  cornua,  a  region 


90  i,e:ucorrhce:a. 

sometimes  neglected.  With  a  well  dilated 
canal,  and  a  definite  plan  of  procedure,  the 
curette  need  not  be  withdrawn  until  the  en- 
tire surface  has  been  gone  over,  and  the 
endometrium  removed.  The  cavity  is  then 
irrigated  with  salt  solution,  which  tends  to 
arrest  oozing,  until  all  shreds  and  particles 
have  come  away.  It  is  then  dried  with  pieces 
of  gauze  carried  up  with  the  uterine  dressing 
forceps,  and  finally  painted  with  Iodine  tinct- 
ure, on  a  swab.  A  few  minutes  will  be  re- 
quired for  the  surplus  Iodine  and  serum  to  be 
discharged,  when  the  cervix  will  be  ready  for 
operation. 

No  hard  and  fast  rules  can  be  laid  down 
for  trachelorrhaphy.  A  simple  bilateral  lac- 
eration, the  most  frequent  variety  of  tear,  re- 
quires an  equally  simple  technique.  Holding 
the  cervix  with  a  volsellum,  the  posterior  sur- 
face of  the  laceration — I  usually  attack  the 
left  side  first — is  denuded  w4th  sharp  pointed, 
strong  scissors,  up  to  and  beyond  the  angle  of 
the  tear.  The  incision  includes  the  mucous 
membrane  of  the  portio-vaginalis,  the  cervi- 
cal endometrium,  and  the  intervening  mus- 
culature.   The  cut  must  be  smooth,  and  suffi- 


VOIvSKl/IvA   FOR  TRACHi:i,ORRHAPHY.      91 

ciently  deep  to  remove  all  diseased  structures, 
and  sufficiently  broad  to  insure  good  surfaces 
for  union.  The  denuded  surface  must  ex- 
tend well  beyond  all  glandular  hyperplasia. 
The  same  procedure  is  followed  on  the  an- 
terior lip,  and  then  on  the  opposite  side  of 
the  cervix.  By  undue  dragging  on  one  lip 
this  is  liable  to  be  disproportionately  elongat- 
ed, and  embarrass  accurate  coaptation  of  the 
flaps.  To  avoid  this,  and  overcome  the  diffi- 
culty, I  have  had  made  a  double  volsella  that 
engages  both  anterior  and  posterior  lips  at 
the  same  time,  separating  them  as  widely  as 
may  be  desired  while  they  are  being  denuded, 
by  bringing  the  handles  of  the  instrument  to- 
gether. This  operation  becomes  more  com- 
plicated when  there  are  several  lacerations. 
It  is  then  usually  better  surgery  to  amputate 
the  cervix  above  the  apex  of  the  tears,  for 
sutures  will  not  hold  in  the  narrow  strips  of 
cervical  tissue  that  are  left  between  the  lac- 
erations. 

I  use  a  short,  slightly  curved  heavy  needle, 
and  silk  worm  gut  sutures.  These  cause 
less  irritation  than  any  other  material,  and 


92  I^EUCORRHCE^A. 

can  be  removed  with  ease  if  the  loose  ends 
are  tied  together,  the  sutures  for  each  lacera- 
tion forming  a  separate  bundle. 

To  insure  healing  the  denuded  surfaces 
must  be  carefully  brought  together.  It  is  a 
common  mistake  to  allow  the  mucous  mem- 
brane of  the  portio-vaginalis  to  become  in- 
verted when  tying  the  sutures.  Wherever 
this  occurs  healing  fails  to  take  place  be- 
tween the  edges  of  the  laceration,  and  in  con- 
sequence the  integrity  of  the  cervix  is  not 
restored.  An  extreme  result  of  this  vicious 
union  is  a  cervical  canal  of  mucous  mem- 
brane only,  the  muscular  structures  having 
been  kept  apart  by  introducing  mucosa  be- 
tween the  lines  of  union.  This  inversion  of 
the  mucous  membrane  may  also  be  caused  by 
tying  the  sutures  unduly  tight,  under  the 
erroneous  impression  that  it  is  necessary  to 
hold  the  parts  in  close  contact.  Surgical  ten- 
sion is  as  objectionable  in  trachelorrhaphy 
as  in  any  other  operation,  and  is  followed  by 
quite  as  disastrous  results.  The  sutures 
should  hold  the  parts  in  contact,  no  more,  and 
allowance  must  be  made  for  traumatic  sv/ell- 
ing,  which  is  sure  to  take  place  during  the 


CONSTITUTIONAL   TREATME^NT.  93 

first  forty-eight  hours.  Silk-worm  gut 
sutures  may  remain  in  position  several 
weeks,  and,  if  possible,  should  not  be  remov- 
ed until  the  next  menstrual  period  has 
passed. 

It  must  not  be  expected  that  curettage  and 
repairing  the  lacerated  cervix  will  be  follow- 
ed immediately  by  a  cure  of  the  catarrh.  It  is 
to  be  hoped  that  the  purulent  element  will  be 
removed,  if  it  is  not  both  operations  will 
fail,  but  a  mucous  discharge  frequently 
remains  that  will  require  continued  douch- 
ing, and  possibly  the  further  use  of  medicat- 
ed tampons. 

The  constitutional  treatment  of  purulent 
gynaecological  catarrh  will  be  on  lines  similar 
to  those  that  have  been  marked  out  for  the 
treatment  of  the  mucopurulent  variety.  The 
hygiene  of  the  patient  is  of  the  first  import- 
ance, and  must  be  regulated  at  every  point 
that  touches  the  functions  of  the  organs  and 
parts  involved.  Even  more  than  in  muco- 
purulent catarrh  the  general  health  suffers, 
for,  in  addition  to  the  tax  imposed  upon  the 
reparative  processes,  there  is  a  toxaemia  that 
interferes  with  metabolism  in  a  very  special 
manner. 


94  I^DUCORRHC^A. 

The  tissue  remedies  again  come  promi- 
nently to  the  foreground.  Calcarea  sulphuri- 
ca,  and  Silicea,  hold  the  most  conspicuous 
positions.  Especially  do  I  rely  upon  the  lime 
salt.  Sulphur  will  be  found  of  service  as  an 
intercurrent  remedy  when  the  case  is  run- 
ning a  chronic  course,  and  apparently  stand- 
ing still.  Kali  phosphoricum  I  use  to  meet 
the  neurasthenia  always  present  in  cases  of 
long  standing.  Its  exhibition  does  not  inter- 
fere with  any  other  remedy  that  may  be  in- 
dicated. Much  has  been  said  in  favor  of 
Echinacea  for  purulent  diseases.  I  have 
used  it  internally  and  externally  with  but  in- 
different results.  To  obtain  anything  from 
its  exhibition  we  must  give  it  in  material 
doses :  One  drachm  of  the  tincture  every 
two  or  three  hours.  Locally,  I  have  used  a 
preparation  of  the  tincture,  one-half  gly- 
cerine. 

D.     Sanguine:ous  Catarrh. 

The  propriety  of  considering  sanguineous 
catarrh  a  distinct  gynecological  disease  rests 
upon  well  defined  pathological  and  clinical 
data,   for  while  any  one  of  the  preceding 


SKNII^E  I^NDOMKTRITIS  AND  COIyPlTlS.   95 

varieties,  simple,  mucopurulent  and  purulent 
catarrh,  may  from  an  intensity  of  the  process 
contain  blood,  adding  a  sanguineous  element 
to  the  already  established  disease,  sanguin- 
eous catarrh  presents  a  wholly  different  his- 
tory which  separates  it  from  all  other  varie- 
ties of  gynaecological  catarrh. 

Sanguineous  catarrh  is  essentially  a  dis- 
ease of  the  uterus,  though  in  women  who 
have  passed  the  menopause  the  vagina  may 
become  implicated,  the  entire  genital  mucosa 
suffering  degeneration, — senile  endometritis, 
senile  colpitis.  Occurring  during  the  repro- 
ductive period  of  life,  sanguineous  catarrh 
represents  a  dift'use  hyperplasia  of  the  endo- 
metrium, not  inflammatory  in  character. 
The  mucosa  is  uniformly  thickened  and  ex- 
tremely vascular.  There  is  a  glandular  out- 
growth, the  glands  themselves  assuming  a 
most  complex  arrangement.  New  vessels 
are  numerous,  and  in  consequence  of  their 
thin  walls  there  are  frequent  haemorrhages 
into  the  endometrium,  the  infiltrated  blood 
showing  as  dark  ecchymotic  spots  on  the  sur- 
face of  the  vagina. 

The   reverse   of   this   hyperplastic   endo- 


96  IvEUCORRHCEA. 

metritis  is  found  in  senility,  though  the 
bloody,  watery  catarrh  is  common  to  both 
diseases.  The  glandular  structures  are  in 
process  of  degeneration,  or  may  entirely  dis- 
appear. Only  patches  of  epithelium  remain, 
connective  tissue  being  greatly  in  excess  of 
glandular  tissue.  But  few  vessels  are  found, 
and  these  are  thickened  or  obliterated.  In  the 
vagina  the  degeneration  is  marked  by  dis- 
colorations  of  different  size,  over  which  the 
epithelium  is  very  thin  or  entirely  absent. 
The  whole  vagina  is  shrunken  and  anaemic 
save  in  isolated  spots  from  which  the  bloody 
oozing  takes  place,  and  between  which  ad- 
hesions of  the  vaginal  walls  are  contracted. 
Much  the  same  condition  is  noted  in  senile 
purulent  catarrh,  save  that  in  the  sanguin- 
eous variety,  even  though  advanced,  there  is 
no  pus.  The  essential  micro-organisms  de- 
termine these  differences.  Thus  we  find  that 
sanguineous  catarrh  may  arise  from  wholly 
different  conditions,  according  to  the  age  of 
the  patient,  hyperplasia  in  adult  life,  atrophy 
in  senility. 

The  etiology  of  sanguineous  catarrh   is 
rather  obscure.     The  hyperplastic  form  is 


HYPKRPIvASTiC   AND   ATROPHIC    I^ORM.    97 

probably  due  to  some  menstrual  irregularity, 
or  more  frequently  is  connected  with  sub- 
involution of  the  uterus.  Retroflexion  may 
also  act  as  a  predisposing  cause,  though  it 
must  be  acknowledged  that  any  one  of  these 
conditions  may  exist  without  giving  rise  to 
hyperplastic  degeneration  of  the  endo- 
metrium. 

The  atrophic  form  is  due  to  a  vicious  fold- 
ing up  of  the  reproductive  function,  but  why 
this  should  be,  save  upon  the  basis  of  some 
dyscrasia,  we  cannot  say.  Neither  variety 
can  be  removed  from  the  field  of  micro-or- 
ganism activity. 

The  clinical  basis  for  classification  is  a 
thin  mucous  discharge  containing  blood,  or 
composed  mostly  of  blood.  Prior  to  the  men- 
opause— hyperplastic  form — the  discharge  is 
never  continuous,  but  takes  place  intermit- 
tently, sometimes  as  an  apparent  prolonga- 
tion of  menstruation,  but  more  frequently 
for  a  varying  period  between  the  monthly 
flow.  The  intermittent  character  of  the  dis- 
charge in  sanguineous  catarrh  will  serve  to 
distinguish  this  from  the  bloody  discharge 
that  belongs  to  more  serious  uterine  dis- 


98  i,kucorrhce:a. 

eases.  Sarcoma  which  also  attacks  adult 
life  gives  rise  to  a  watery  discharge  contain- 
ing blood,  but  this  is  more  or  less  continuous, 
and  may  become  at  times  an  actual  haemor- 
rhage, an  extreme  condition  not  found  in 
sanguineous  catarrh,  in  w^hich  the  discharge 
is  made  up  of  blood  and  mucus.  Moreover 
an  examination  will  determine  the  nature  of 
the  disease. 

Sanguineous  catarrh  may  occur  in  3^oung 
girls  at  the  establishment  of  menstruation. 
It  is  apt  to  follow  the  flow  for  several  days, 
or  to  appear  during  the  interval.  It  is  al- 
ways an  indication  of  congestion  of  the  en- 
dometrium, with  more  or  less  degeneration 
of  its  blood  vessels.  The  condition  of  the  lin- 
ing of  the  uterus  may  be  associated  with 
some  malposition  of  the  uterus,  more  fre- 
quent at  this  early  age  than  is  generally 
recognized. 

Sanguineous  catarrh  of  senility  is  a  con- 
tinuous discharge,  usually  nothing  more 
than  an  oozing,  that  keeps  the  vulva  moist. 
It  is  inclined  to  be  irritating  and  offensive, 
but  both  of  these  conditions  depend  largely 
upon  the  habits  of  the  patient,  and  are  rem- 


tre:atmknt.  99 

edied  by  douching  and  attention  to  local 
cleanliness  and  hygiene.  In  making  our 
diagnosis  the  suspicious  character  of  any 
bloody  vaginal  discharge  after  the  meno- 
pause will  not  be  lost  sight  of.  Reference 
has  been  made  to  this,  but  its  importance 
cannot  be  too  strongly  emphasized. 

The  treatment  of  the  sanguineous  gynae- 
cological catarrh  of  adult  life  is  very  satis- 
factory. Occurring  before  marriage  it  can 
almost  always  be  cured  with  such  remedies 
as  Calcarea  carb.,  Sepia,  Helonias,  Collin- 
sonia,  Hydrastis,  or  Pulsatilla,  without  other 
local  medication  than  douching  with  Hy- 
drastis, Iodine,  Boracic  acid,  or  Permangan- 
ate of  potash.  Any  malposition  of  the 
uterus  will  be  corrected,  and  the  patient's 
general  condition  will  receive  such  attention 
as  may  be  required. 

In  pelvic  conditions,  especially  those  asso- 
ciated with  local  congestion,  much  benefit 
may  be  derived  from  the  use  of  medicated 
baths.  The  milder  cases  would  not  be  will- 
inp;-  to  submit  to  the  inconvenience  attending 
such  treatment,  but  a  course  of  baths  at 
Vichy,  Homburg,  Kissengen,  in  Europe,  or 


100  I,i:UCORRHC^A. 

at  Mt.  Clemens,  the  Hot  Springs  or  the 
White  Sulphur  Springs  in  this  country,  or 
even  hot  salt  baths  at  home,  will  more  than 
repay  the  severer  cases  by  the  relief  afford- 
ed and  the  additional  povv'er  of  recuperation 
thereby  established.  In  chronic  vulvo- 
vaginitis, and  catarrh,  sea  baths  are  to  be 
recommended,  or  a  home  bath  containing : 

^.     Sodium  chloride   lb.  ii. 

Sodium  carbonate    Svi. 

M. 

It  may  become  necessary  to  curette  the 
uterus,  to  remove  the  hyperplastic  endo- 
metrium, and  treat  the  basement  membrane 
directly  with  a  view  to  restoring  the  func- 
tion of  the  uterine  cavity.  Curettement  is 
the  same  as  under  other  conditions,  the  same 
complete  dilation  of  the  cervix,  and  thor- 
ough covering  of  the  diseased  area  vvill  be 
observed. 

I  use  chiefly  two  remedies  for  sv/abbing 
out  the  uterine  cavity  after  curettement. 
The  tincture  of  Iodine  again  comes  to  the 
front,  sometimes,  however,  I  use  a  ten  per 
cent,  solution  of  Argyrol.   Iodine,  as  in  most 


LOCAL  TREATMENT.  101 

intra-uterine  treatment,  is  more  frequently 
indicated,  but  Argyrol  will  be  of  service 
when  the  detritus  removed  contains  much 
granulation  tissue,  the  same  conditions  that 
elsewhere  suggest  the  use  of  Silver  nitrate. 
In  some  chronic  cases  it  may  be  necessary 
to  repeat  the  scraping,  but  an  ultimate  cure 
may  confidently  be  looked  for. 

The  sanguineous  catarrh  of  senility — 
atrophic  variety — does  not  warrant  so  favor- 
able a  prognosis.  The  structural  changes 
are  a  part  of  the  degeneration  of  age,  and 
being  in  excess  of  the  normal  process,  and 
characterized  by  lawlessness  of  function,  are 
difficult  to  arrest,  since  the  entire  organism 
is  losing  its  reparative  power  and  tending 
to  decay. 

Local  treatment,  save  in  the  form  of 
douches,  is  not  generally  practicable.  The 
vaginal  walls  are  hard  and  unyielding,  and 
even  the  use  of  a  speculum  is  liable  to  injure 
the  thinly  covered  mucous  membrane,  add- 
ing a  denuded,  and  ultimately  an  ulcerated 
surface  to  an  already  poorly  nourished 
vagina.  A  douche  of  Hydrastis,  fluid  ex- 
tract, or  when  an  astringent  is  required,  of 


102  I^EUCORRHCEA. 

Zinc  chloride,  ten  grains  in  one  quart  of 
water,  will  yield  good  results. 

For  the  pruritus,  so  frequently  such  an 
annoying  symptom,  and  one  that  in  extreme 
cases  renders  existence  almost  unendurable, 
depriving  the  patient  of  rest  during  both  day 
and  night,  the  treatment  already  suggested 
may  prove  efficacious;  it  sometimes,  how^- 
ever,  becomes  necessary  to  cauterize  the  sur- 
face with  the  object  of  destroying  the  cu- 
taneous nerves.  We  will  think  of  the  Nitrate 
of  silver : 

^.     Silver  nitrate gr.  xii. 

Distilled  w^ater   5i. 

M. 

Or  the  actual  cautery  may  be  required. 
These  measures  failing,  I  have  resorted  to 
removal  of  the  entire  external  genital 
organs,  ablating  the  vulva,  and  even  the 
clitoris  with  its  prepuce.  The  possibility  of 
sensory  nerves  becoming  involved  in  cica- 
tricial tissue  is  always  to  be  apprehended, 
but  one  case  of  long  standing  in  which  I  per- 
formed this  operation,  was  entirely  cured, 
the  patient,  who  was  unmarried,  subsequent- 


RADICAI,  TRE:aTME:nT.  103 

ly  marrying,  became  the  mother  of  several 
children.  It  will,  of  course,  be  understood 
that  I  do  not  advocate  this  radical  treatment 
until  every  other  means  of  cure  has  been  ex- 
hausted. 


CHAPTER  IV. 

THERAPEUTICS. 

PART  I. 

THERAPEUTIC  SUGGESTIONS. 

Actearac.  Profuse  mucous  catarrh.  Weight  and 
bearing  down  of  the  uterus.  Spasms  of  the 
broad  Hgament.  Rheumatic  pains  in  the 
back  and  through  the  pelvis,  the  pains  run- 
ning down  the  legs,  which  feel  numb.  Fron- 
tal headache.  Great  mental  depression. 
Subinvolution  of  the  uterus. 

yEscuhis  hippocastamim.  Chronic  muco-puru- 
lent  catarrh,  dark,  yellow,  thick  and  stringy, 
corroding.  Retroversion  of  the  uterus,  which 
is  enlarged  and  indurated,  with  heat  and 
throbbing.  With  the  discharge  there  is 
marked  lameness  across  the  sacro-iliac  artic- 
ulation. Hemorrhoids,  constipation,  and  con- 
gestion of  the  portal  system.  Neuralgic  pains 
that  fly  rapidly  from  spot  to  spot.  Stunning 
pain  in  the  head  with  extreme  irritability. 
Dull  aching  in  the  occiput  spreading  to 
the  neck  and  shoulders. 

Agnus  castus.  Copious  transparent  (cervical) 
catarrh  which  stains  the  linen  yellow.  Sex- 
ual excitement  with  relaxation  of  the  genital 
organs.  Conditions  caused  by  ungratified 
sexual  desire,  or  from  exhaustion  following 
excessive  indulgence.  Mental  dullness,  and 
depression. 


106  i,e;ucorrhce:a. 

Aloe  socotrina.  Sanguineous  catarrh  of  old 
women,  the  mucus  appearing  in  jelly  like 
lumps.  Pain  and  fullness  in  women  past  the 
climacteric,  as  of  approaching  menses,  re- 
lieved by  a  sudden  flow  of  bloody  mucus. 
Bloody  mucus  in  the  place  of  stool,  the 
patient  thinking  it  would  be  diarrhoea.  Pres- 
sure and  heaviness  in  the  sacrum  relieved  by 
walking. 

Alumen.  Copious  muco-purulent  catarrh  from 
an  eroded  cervix.  The  uterus  is  hard,  and 
denuded  spots  and  granulations  are  found  in 
the  vagina.  The  discharge  is  irritating,  in- 
ducing pruritus  vaginae.  There  is  extreme 
sensitiveness  of  the  vagina  interfering  with 
an  examination.  The  left  ovary  is  enlarged, 
sensitive,  and  the  seat  of  severe  pain.  There 
is  constipation  from  dryness  of  the  rectum, 
the  hard  faeces  being  expelled  with  difficulty. 
It  is  characteristic  of  the  urine  of  Alumen 
that  it  is  covered  with  an  oily  iridescent  film. 

Alumina.  Very  profuse  transparent  catarrh, 
acrid,  corrosive,  aggravated  during  the  day. 
Thin,  light  yellow  excoriating  discharge, 
inducing  inflammation  and  swelling  of  the 
vagina.  The  urine  passing  over  the  parts 
causes  intense  burning.  Prolapsus  of  the 
uterus.     Deep  erosions  of  the  cervix. 

Ainbra  grisea.  Bluish  white  catarrh  accompan- 
ing  nymphomania.  Thick  mucous  catarrh 
during  the  night.     Pruritus  vulva.     Soreness 


THERAPEUTIC   SUGGESTIONS.  107 

and  swelling  of  the  vulva.  All  the  uterine 
symptoms  are  aggravated  by  lying  down. 
Ambra  grisea  will  be  thought  of  for  the 
catarrh  of  young  girls,  nervous  girls  who 
suffer  from  chlorosis,  or  when  the  catarrh 
follows  a  protracted  illness  from  which  recu- 
peration has  been  slow. 

Ammonium  carbonicmn.  Acrid,  watery,  burning 
catarrh  causing  excoriation  and  ulceration  of 
the  vulva,  with  sloughing.  There  is  conges- 
tion and  excitement  of  the  sexual  organs. 
Hysteria,  with  listlessness,  and  lethargy. 
Hemorrhagic  diathesis  from  fluidity  of  the 
blood.  Indicated  for  stout  women  who  lead 
a  sedentary  life,  and  readily  take  cold  in 
winter. 

Ammonium  muriaticum.  Catarrh  resembling 
the  white  of  Qgg,  preceded  by  griping  pains 
about  the  navel.  Brown,  slimy  catarrh  in- 
creased after  urinating.  Uterus  large  and 
heavy.  Menstrual  flow  more  profuse  at 
night.  Obstinate  constipation,  stools  hard 
and  crumbling.  Strained  feeling  in  the 
groins,  causing  the  patient  to  walk  bent  over. 

Anacardium  orientale.  Catarrh  causing  soreness 
and  itching.  Menses  scanty  but  too  fre- 
quent, the  catarrh  continuing  between  the 
periods. 

Angustura.  Catarrh  resembling  milk,  becoming 
green.  Catarrh  immediatel}^  before  the 
menses.  Prolapsus  of  the  uterus.  Itching 
pustules  on  the  labia. 


108  I,EUCORRH<^A. 

A7itimo7iium  cried.  Very  acrid  watery  catarrh, 
containing  lumps  of  mucus,  and  causing 
smarting  wherever  it  touches.  Nympho- 
mania following  checked  menstruation.  Very 
sensitive  to  cold  air.  Acne  of  young  girls. 
Ill  effects  of  suppressed  eruptions. 

A7ttinio7tiu7n  tartaricum.  Sanguineous  catarrh, 
worse  when  sitting,  coming  in  paroxysms. 
Pustules  on  the  labia  with  violent  itching. 
Chronic  metritis.  Prostration  and  general 
weakness  out  of  proportion  to  the  apparent 
condition. 

Apis.  Catarrh  acrid,  profuse,  green,  with  fre- 
quent painful  urination.  Neuralgic  pains  in 
the  labia.  Swelling  of  the  right  labium. 
CEdema  of  the  vulva.  Right  ovarian  neu- 
ralgia. 

Argenttim  iiitricmn.  Bloody,  corroding,  yellow, 
and  profuse  catarrh.  The  uterus  is  pro- 
lapsed, and  soft.  Erosion  of  the  cervix  with 
exuberant  granulations,  in  some  places  there 
are  excavating  ulcers  which  bleed  easily. 
The  nervous  symptoms  and  the  pelvic  symp- 
toms recur  with  marked  regularity.  The 
vaginal  mucous  membrane  is  dotted  with 
ecchymotic  spots  owing  to  the  specific  action 
of  the  Nitrate  of  Silver  on  the  red  blood  cor- 
puscles. The  patients  look  old  for  their  age, 
and  suffer  with  nervous  headaches  from 
mental  causes. 

Arsenicum.     There  is  a  white  offensive  discharge 


the:rapeutic  sugge:stions.         109 

instead  of  the  menses.  Catarrh  acrid,  cor- 
rosive, thick  and  yellow.  All  the  catarrhs  of 
Arsenicum  cause  intense  burning.  Sanguin- 
eous catarrh  of  old  women,  very  acrid,  and 
offensive.  The  keynote  of  Arsenicum  is 
burning.  It  may  be  internal  or  external,  but 
is  always  present.  There  is  marked  emacia- 
tion and  pallor,  with  blue  rings  around  the 
eyes.  Especially  adapted  to  youth  and  ado- 
lescence.    Anaemia. 

Asafoetida.  Catarrh  profuse,  greenish,  and  of- 
fensive. Erosion  of  the  cervix.  Hysterical 
women,  weak  and  delicate,  suffering  from 
oversensitiveness.     Very  changeable  moods. 

Asaruin  Eiiropoen7n.  Tenacious  yellow  catarrh 
occurring  two  or  three  months  after  confine- 
ment. Suitable  for  plethoric  young  mothers 
who  have  suffered  for  years  with  headaches. 
A  dull  pressure  over  the  whole  head. 

Aurum  metallicuni.  Thick  white  catarrh  causing 
burning  and  smarting  of  the  vulva,  the  labia 
majora  are  red  and  swollen.  Profuse  yellow 
corroding  catarrh.  Prolapsus  of  the  uterus 
with  backache.  There  is  a  constant  oozing 
of  mucus  from  the  vagina.  Extreme  mental 
depression. 

Aurum  muriaticinn.  Light  yellow  catarrh,  espe- 
cially in  the  morning.  Uterus  prolapsed  and 
indurated.  Chronic  metritis.  Vaginitis. 
Burning,  heat  and  itching  in  the  vagina. 
Sterility. 


no  i.i:ucorrhce:a. 

Baryta  carbonica.  Sanguineous  catarrh  of  old 
women,  with  palpitation  of  the  heart,  pain 
in  the  back,  weakness  and  fainting.  Vaginal 
discharge  immediately  before  menstruation. 
The  patient  is  always  tired.  Catarrh  during 
the  climacteric.  Especially  suitable  for 
dwarfish  women  of  soft  lax  fibre. 

Berberis.  Acrid  catarrh,  vaginitis  with  intense 
itching  and  burning,  with  sensation  of  raw- 
ness of  the  vagina.  Alone  these  symptoms 
are  not  characteristic,  but  when  accompanied 
with  biliousness,  or  inflammation  of  the 
urinary  organs,  they  may  become  so,  and 
should  be  studied  for  further  indications. 

Bo7'ax.  Catarrh  like  the  white  of  ^^g,  with  sen- 
sation as  if  warm  water  were  flowing  over 
the  parts.  White  albuminous  or  scanty  dis- 
charge. Acrid  catarrh  between  the  menses. 
Profuse  clear  gelatinous  discharge  relieving 
all  the  other  genital  symptoms.  Aphthae  of 
the  vagina  and  vulva. 

Bovista.  Catarrh  a  few  days  after,  or  a  few  days 
before  menstruation,  resembling  the  white  of 
^^'^y  aggravated  while  walking.  Yellow, 
green,  acrid,  corrosive  discharge  that  leaves 
green  spots  on  the  clothing.  Thick,  slimy, 
tough  discharge.  Soreness  between  the 
labia,  and  thighs.  Tendency  to  moist  erup- 
tions on  the  skin.  The  mental  state  is  one 
of  irritability,  with  inclination  to  misconstrue 
the  motives  of  others. 


Therapeutic  suggestions.         Ill 

Bromine.  Milk  white  catarrh  with  much  pain  in 
the  left  ovary,  which  is  hard  and  sensitive. 
Vagina  sore  and  painful.  Swelling  of  the 
lymphatics  without  suppuration,  in  various 
regions  of  the  body.  Conditions  remaining 
after  scarlatina.  Suitable  for  adults  with 
blue  eyes  and  light  hair,  fair  papery  skin. 
Scrofulous. 

Btifo7ies.  Muco-purulent  catarrh.  Purulent 
catarrh.  Offensive.  Ulceration  of  the  cer- 
vix uteri  with  burning  pains.  Sharp  pains  in 
the  uterus. 

Calcarea  carbonica.  Catarrh  like  milk,  with  itch- 
ing and  burning  before  and  after  menstrua- 
tion. Profuse,  coming  in  fits  and  starts. 
Aggravated  after  exercise,  with  great  debil- 
ity. Burning  in  the  uterus.  Chlorosis. 
Pruritus  with  heat  of  the  parts.  Discharge 
acrid,  corroding  the  genitals.  Varices  of  the 
labia.  Intense  itching  and  soreness  of  the 
vulva.  Purulent  catarrh  with  swelling  of  the 
vulva,  and  inflammation.  Menses  too  early 
and  last  too  long.  The  least  excitement 
causes  a  return  of  menstruation. 

Calcarea  phosphorica.  Catarrh  like  the  white  of 
^^%,  creamy  discharge.  Much  aching  in  the 
vagina.  Throbbing  and  stinging  in  the 
vulva.  Menses  too  early.  Great  sexual  ex- 
citement, with  congestion  of  the  erectile 
organs.  Constant  voluptuous  sensation  in 
the  external  parts  with  pulsation  as  if  filling 


112  IvI^UCORRHCHA. 

with  blood.  Young  girls  who  have  been  dis- 
appointed in  love. 

Calcarea  sulphurica.  Profuse  purulent  catarrh. 
Menstruation  is  delayed,  but  continues  too 
long.  The  discharge  contains  lumps  of  pus, 
and  may  be  bloody.  Pustules  develop  on 
the  vulva,  and  other  parts,  which  rapidly 
pass  to  the  stage  of  suppuration. 

Cannabis  sativa.  Infantile  gynaecological  catarrh. 
In  the  absence  of  other  history  there  is 
always  the  suspicion  of  gonorrhoea,  but  gen- 
ital catarrh  in  children  does  undoubtedly 
arise  from  other  causes. 

Cantharis.  Muco-purulent  catarrh  containing 
shreds  of  mucus,  blood,  and  desquamated 
epithelium.  The  key  note  of  cantharides  is 
irritation.  There  is  oversensitiveness  of  all 
the  sexual  parts.  The  ovarian  regions  are 
sensitive  to  pressure,  with  bearing  down. 
Vaginismus.  Swelling  and  irritation  of  the 
vulva.  Portio  vaginalis  swollen.  Irritation 
of  the  bladder  with  the  characteristic  dysuria 
of  this  drug. 

Carbo  animalis.  Offensive  muco-purulent  catarrh 
which  stains  the  clothing  yellow.  Corrod- 
ing, burning,  aggravated  when  standing  or 
walking.  Uterus  swollen;  slimy,  bloody 
catarrh.  All  the  discharges  are  offensive. 
Prostration  is  marked,  and^  the  local  path- 
ology suggests  malignancy.  Carbo  an.  will 
be  found  serviceable  for  young  women,  and 


thkrapeutic  suggestions.        113 

elderly  persons,  especially  those  suffering 
from  venous  plethora,  with  blue  cheeks,  and 
blue  lips. 

Car  bo  vegetabilis.  Catarrh  thin,  aggravated  in 
the  morning  on  rising,  scanty  during  the  day. 
Milky,  excoriating,  thin,  yellow,  preceding 
or  following  the  menses,  intermitting,  coming 
and  going  suddenly,  with  rawness  and  sore- 
ness of  the  labia.  Swelling  of  the  vulva. 
Prurigo,  varices  and  itching  of  the  vulva. 
Red  sore  spots  on  the  pudenda,  aphthae. 
Lassitude  and  general  weakness.  The  ca- 
tarrh is  of  long  standing.  Acts  well  on  old 
persons. 

Carbolic  acid.  Copious,  fetid,  greenish  acrid 
catarrh,  especially  following  profuse  men- 
struation. The  uterine  cervix  is  hard,  and 
eroded. 

Caulophyllmn  tlialictroides.  Acrid  catarrh,  very 
weakening.  Profuse,  bland,  mucous  catarrh 
with  '*  moth  spots  "  on  the  forehead  in  young 
girls.  Profuse,  mucous  catarrh  with  conges- 
tion of  the  uterus,  and  forcing  down  pains. 
Aphthous  vaginitis.  Menstrual  colic,  uterus 
retroverted.  Hysteric  convulsions  during 
dysmenorrhoea.     Catarrh  in  little  girls. 

Caiisticinn.  Catarrh  having  the  same  odor  as 
menstruation,  at  night  only.  Clear  ropy 
acrid  catarrh  with  itching  and  smarting  of 
the  vulva.  Urine  acrid,  causing  biting  like 
salt  of  the  pudendum.  Menstruation  during 
9 


114  I^KUCORRHC^A. 

the  day  only.  The  capillaries  are  near  the 
surface  showing  as  a  fine  net  work  under 
the  skin,  in  various  parts  of  the  body. 

Cedron.  Catarrh  regularly  every  month  five  or 
six  days  previous  to  the  catamenia,  with 
pain  in  the  uterus  and  swelling  of  the  vulva. 
Catarrhal  discharge  appearing  in  the  place 
of  the  menstrual  flow.  Menstrual  epilepsy. 
All  the  symptoms  recur  with  clock  like  regu- 
larity. Adapted  more  especially  to  women 
of  a  voluptuous  disposition,  and  of  an  ex- 
citable temperament. 

Chamomilla.  Acrid  biting  watery  discharge, 
particulary  after  eating.  Yellow  smarting 
catarrh,  causing  burning  in  the  vagina  as  if 
excoriated.  Many  menstrual  symptoms 
with  intolerance  of  any  suffering.  Physical 
and  mental  irritability.  Excitable  tempera- 
ment. 

Chelidonijim  majiis.  Acrid  catarrh.  There  is 
nothing  characteristic  in  this  symptom,  but 
when  taken  in  connection  with  the  well 
known  hepatic  and  gastric  action  of  Cheli- 
donium  it  may  assist  in  selecting  the  individ- 
ual remedy. 

Cinchona  officinalis.  Sanguineous  catarrh.  Pur- 
ulent catarrh.  Acrid  catarrh  in  the  place  of 
the  menses,  with  itching,  contraction  of  the 
uterus,  and  bearing  down.  Bloody  catarrh 
containing  clots  one  week  before  the  menses. 
Painful  induration  of  the  vagina.      Ovaritis 


the:rapi:utic  suggestions.        115 

from  sexual  excesses.  Cinchona  is  suitable 
for  women  who  have  passed  the  climacteric, 
and  when  there  is  exhaustion  from  loss  of 
any  of  the  fluids  of  the  body. 

Cinnabaris.  Genital  catarrh,  the  discharge  of 
which  causes  pressure,  or  labor  like  pain  in 
the  vagina. 

Cocculus.  Catarrh  of  mucus,  purulent,  ichorous. 
Discharge  of  bloody  water,  resembling  the 
washings  of  meat,  gushing  out  when  bend- 
ing, or  squatting.  Menstruation  gradually 
more  scanty  until  catarrh  takes  its  place, 
the  discharge  then  becoming  continuous. 
There  is  hypersesthesia  of  all  the  senses, 
and  an  exalted  susceptibility  to  impress- 
ions. A  slight  noise  or  unsuspected  touch 
induces  starting  and  trembling  all  over 
the  body.  Persistent  occipital  headache, 
with  a  peculiar  swimming  sensation  as  of 
seasickness. 

Coffea  crtida.  Profuse  discharge  of  bloody  mucus 
preceded  by  paroxysms  of  colic,  voluptuous 
itching,  and  sexual  excitement.  Mucous,  or 
milky  catarrh  when  urinating,  sensitiveness 
of  the  vulva.  Overexcitement  of  the  entire 
nervous  system.  Cerebral  erethism.  Ure- 
thral caruncle. 

Collinsonia  Canadensis.  Discharge  of  mucus — 
simple  catarrh — with  obstinate  constipation, 
and  dysmenorrhcea.  Pruritus  valva.  All 
the  pelvic  systems  depend  upon  congestion 


116  IvEUCORRHCE^A. 

of  the  portal  vessels.  There  is  congestion  of 
the  cervix,  congestion  of  the  uterus,  conges- 
tion of  the  rectum,  with  haemorrhoids. 

Colocynthis.  Thick,  yellow,  offensive  catarrh 
between  the  menses.  Swelling  of  the  labia 
with  dragging  pain  and  heat  in  the  vagina. 
The  cramping,  cutting  pains  of  Colocynthis 
that  are  made  better  by  relieving  muscular 
tension  are  valuable  indications. 

Conium  maciilatum.  Discharge  of  mucus  follow- 
ing uterine  spasm.  Bloody  catarrh  in  the 
place  of  menstruation.  Acrid  and  burning 
catarrh,  white  or  yellow,  preceded  by  grip- 
ing and  pinching  in  the  abdomen,  and  lame- 
ness in  the  small  of  the  back.  Profuse, 
bloody  mucus,  excoriating,  thick,  milky  white 
and  acrid  mucus,  causing  burning  and  smart- 
ing. Stitches  in  the  vulva,  itching  of  the 
vulva.  Sero-purulent  eruption  on  the  mons 
veneris.  One  of  the  most  frequently  indi- 
cated remedies  for  erosion  of  the  cervix  with 
characteristic  hardness  and  induration.  This 
may  exist  quite  independently  of  malignancy. 
The  pelvic  condition  calling  for  Conium  can 
frequently  be  traced  to  a  strain,  or  to  a  fall 
that  has  displaced  the  uterus.  It  is  espe- 
cially useful  for  old  women. 

Copaiva.  Bloody  purulent  mucous  discharge 
from  the  uterus  upon  pressure.  Milky,  acrid 
discharge,  strangury.  Throbbing  pain  in  the 
ovaries.     This  drug  is  more  frequently  indi- 


THDRAPKUTIC   SUGGESTIONS.  117 

cated  in  specific  cases,  but  inasmuch  as  it 
induces  profuse  discharges  from  mucous  sur- 
faces generally,  it  may  be  found  useful  in 
non-specific  gynaecological  catarrh. 

Cubeba.  Profuse  chronic  catarrh,  very  acrid, 
green,  yellow  and  offensive.  Vaginitis,  ere- 
thema  on  the  inside  of  the  thighs,  and  pruri- 
tus of  the  vulva.  Uterus  swollen  and  pain- 
ful. Catarrh  takes  the  place  of  the  menses. 
The  urinary  symptoms  of  Cubeba  will  be 
concomitants.  Acrid  catarrh  of  children. 
Acts  well  in  persons  of  a  bilious  tempera- 
ment. 

Curare.  Scanty,  thick,  purulent  foul  discharge 
in  clots.  The  pathology  of  the  cervix  and 
vagina  indicate  the  tissue  destruction  of 
malignancy,  and  may  remove  this  remedy 
from  the  class  of  uncomplicated  gynaecologi- 
cal catarrhs. 

Cyclamen  Europceum.  Catarrh  in  blond,  leuco- 
phlegmatic  subjects,  with  retarded  scanty 
menstruation.  Chlorosis  and  anaemia,  at- 
tacks of  fainting  ;  there  is  constant  chilliness 
of  the  whole  body.  The  menses  cease  when 
moving  about,  reappear  when  sitting  quietly, 
or  when  in  bed. 

Drosera  rotundifolia.  Genital  catarrh  with  labor 
like  pains.  This  may  be  included  in  the 
clinical  picture  that  shows  the  action  of 
Drosera  on  the  pneumogastric  nerve,  pro- 
ducing a  spasmodic  dry  cough  like  whooping 
cough. 


118  I^KUCORRHGSA. 

Dulcamara.  Genital  catarrh  appearing,  or  ag- 
gravated, in  cold  damp  weather,  with  herpetic 
eruptions  on  the  vulva.  Preceding  the  cate- 
menia  there  is  always  some  form  of  skin 
eruption. 

Erigeron.  Profuse  catarrh  with  spasmodic  pains, 
and  irritation  of  the  bladder,  and  rectum; 
usually  scanty  menses.  Chronic  uterine 
catarrh.  Prominently  in  the  pathogenesis  of 
Erigeron  will  be  observed  active  congestion 
of  various  organs,  with  a  tendency  to  haemor- 
rhage. It  is  especially  indicated  for  small, 
frail,  delicate  women. 

Eucalyptus  globulus.  Acrid,  fetid  mucous  ca- 
tarrh. Urethral  caruncle.  The  urine  has 
the  odor  of  violets. 

Eupatorium  purpureum.  Uterine  catarrh,  chronic 
metritis.  Profuse  and  frequent  urinating, 
with  painful  urging. 

Ferrurn.  Discharge  of  mucus  in  the  place  of  the 
menses.  Chlorosis.  Catarrh  before  the 
menses.  Discharge  resembling  watery  milk, 
smarting  and  corroding  when  it  first  appears, 
becoming  more  bland.  Dragging  pains  in 
the  loins,  pelvis  and  thighs.  Much  itching 
of  the  vulva  in  weakly,  delicate  women. 
Face  red.  Menorrhagia,  especially  when 
accompanied  by  a  flushed  face,  and  fol- 
lowed by  a  very  acrid  catarrh.  Laxness  and 
weakness  of  the  entire  musculature  ;  weak 
digestion,  and  cold  extremities.     Anaemia. 


thi:rapi:utic  suggkstions.         119 

Fei^rtim  iodatum.  Catarrh  resembling  boiled 
starch,  which  is  discharged  in  strings  during 
Stool.  Itching  and  soreness  of  the  vulva  and 
vagina  with  swelling.  Constant  bearing 
down  ;  when  sitting  she  feels  as  if  something 
were  being  pushed  up  through  the  vagina. 
Prolapsus  of  the  uterus,  the  cervix  actually 
protruding  from  the  vulva. 

Fluoricum  acidum.  Acrid  excoriating  catarrh 
with  itching.  Chronic  erosion  of  the  cervix, 
with  sharp  darting  pains.  Coccyodynia. 
Varicose  veins.  Congestion  of  the  sexual 
organs. 

Gelsemiurn,  Catarrh  resembling  milk  with  full- 
ness of  the  uterus,  in  nervous,  excitable, 
hysterical  women,  old  maids,  and  students. 
Aching  across  the  lower  part  of  the  back. 
Catarrhal  discharge  in  gushes.  Neuralgic 
pains  with  cramps  in  the  uterus  and  legs. 
Cramps  in  the  utero-sacral  ligaments.  Pain 
from  the  occiput  to  the  forehead,  as  though 
a  knife  were  thrust  through.  All  the  symp- 
toms are  relieved  by  the  free  flow  of  urine. 
Congestion,  both  venous  and  arterial,  with 
sluggish  circulation,  face  red,  and  a  sodden 
expression. 

Graphites.  Catarrh  occurring  in  gushes,  acrid, 
excoriating.  Profuse  catarrh  with  weakness 
in  the  back  and  sacrum.  Yellowish-white, 
that  excoriates  the  skin.  Uterus  indurated 
and    sore.     Catarrh    profuse    and   perfectly 


120  LEUCORRHCKA. 

white,  especially  on  rising  in  the  morning. 
Copious  thin  catarrh,  causing  biting  and 
smarting  in  the  vagina.  Itching,  smarting 
vesicles  on  the  vulva.  CEdema  of  the  vulva. 
Enlarged  ovaries,  becoming  more  tender 
after  getting  the  feet  damp.  Vagina  hot  and 
painful.  Swelling  of  the  lymphatic  vessels 
and  mucous  follicles  of  the  vagina.  The 
neck  of  the  uterus  is  hard  and  swollen. 
Catarrh  in  the  place  of  the  menses.  Tend- 
ency for  the  skin  to  crack  and  form  fissures. 
Moist  eruptions,  the  discharged  fluid  being 
excoriating.  Adapted  to  women  inclined  to 
obesity,  who  suffer  from  habitual  constipa- 
tion, and  whose  history  is  of  delayed  men- 
struation. 

Guarea  trichilioides.  Fetid  catarrhal  discharge 
after  the  menses. 

Hamamelis  Virginica.  Profuse  purulent  catarrh 
with  sensitiveness  of  the  parts,  vagina  sore 
and  raw;  vaginitis.  Relaxation  of  the  walls 
of  the  vagina.  Sanguineous  catarrh  with 
excessive  tenderness  of  the  vagina.  Ovaritis. 
Marked  tenderness  always  suggests  this  rem- 
edy. Venous  stagnation  of  the  skin  and 
mucous  membranes. 

Helonias  dioica.  Catarrh  with  profuse  flooding 
at  the  menopause.  Intense  pruritus  of  the 
vulva  and  vagina  with  curdy  secretion. 
Aphthous  vaginitis.  Labium  and  pudendum 
hot,  red  and  swollen,  with  burning  and  itch- 


the:rapi:utic  sugge:stions.         121 

ing.  Catarrh  with  pains  in  the  lower  part  of 
the  back,  soreness  and  tenderness  of  the 
breasts  and  nipples,  particularly  during 
menstruation.  Catarrh  in  old  women.  Pro- 
lapsus uteri  and  erosion  of  the  cervix,  ca- 
tarrhal discharge  constant,  dark,  offensive, 
aggravated  when  lifting  and  upon  the  least 
exertion.  Vaginal  irritation.  Profuse  watery 
catarrh  in  feeble  women  who  suffer  from 
uterine  displacement,  face  sallow.  Profuse 
menstruation  is  characteristic  of  Helonias. 
Extreme  languor  for  which  she  can  find  no 
cause.  Suitable  for  women  who  are  ener- 
vated by  indolence  and  luxury.  Conditions 
developed  in  connection  with  the  climac- 
teric. 

Hepar  srilph.  calc.  Purulent,  fetid  catarrh. 
Smarting  of  the  vulva.  Erosion  and  ulcera- 
tion of  the  cervix,  the  discharge  having  the 
odor  of  old  cheese.  The  patient  is  ex- 
tremely sensitive  to  open  air,  and  to  changes 
of  temperature.  A  damp  east  wind  aggra- 
vates all  the  conditions.  Very  sensitive  to 
contact,  the  patients  dread  to  be  touched,  out 
of  proportion  to  the  actual  pain  caused. 
There  is  an  offensive  exhalation  from  the 
body. 

Hydrastis  Canadensis.  Uterine  and  vaginal  ca- 
tarrh of  tough,  stringy  mucus.  Purulent 
catarrh.  Hot  watery  discharge  from  the 
uterus.     Acrid,  corroding  catarrh  about  one 


4 


122  I^EUCORRHC^A. 

week  after  menstruation.  Profuse  discharge 
like  the  white  of  egg  immediately  after  men- 
struation, lasting  about  two  weeks;  very  de- 
bilitating. Yellow  tenacious  catarrh  in  long 
threads  and  pieces.  Pruritus  vulva.  Cervix 
swollen,  indurated  and  eroded.  Ulceration 
of  the  cervix.  There  are  almost  always  dis- 
orders of  digestion  when  Hydrastis  is  indi- 
cated. 

Ignatia.  Purulent  corrosive  genital  catarrh  with 
labor  like  pains.  Chronic  catarrh  with  sex- 
ual excitement.  Vaginismus.  Pruritus  of 
young  girls,  with  catarrh.  Suppressed  grief. 
Rapidly  changing  moods.  Melancholia. 
Irritable  and  impatient,  sad,  concealing  her 
grief  from  others. 

Inula.  A  moving  about  in  the  abdomen  as  at 
the  appearance  of  the  menses,  followed  by 
yellowish  catarrh.  Stitches  in  the  region  of 
the  uterus  and  genitals.  Urine  smells  like 
violets. 

Iodi7ie.  Thin,  yellow  catarrh  in  scrofulous 
women,  with  induration  and  swelling  of  the 
OS  uteri  and  engorgement  of  the  vagina. 
Chronic  catarrh  most  profuse  at  the  time 
of  menstruation,  causing  soreness  of  the 
thighs,  and  corroding  the  linen.  Corrosive 
catarrh  in  women  subject  to  chronic  menor- 
rhagia.  Hardness  and  swelling  of  the  cervix. 
Weakness  and  loss  of  breath  on  going  up 
stairs.  Uterine  catarrh  alternating  with 
cough.     Gradual  emaciation. 


THE:rAPI:uTIC    SUGGi:STlONS.  123 

Kali  bichromicum.  Catarrhal  discharge  that  can 
be  drawn  out  in  long  strings.  Yellow  ropy, 
stiffening  the  linen.  Pruritus.  Subinvolu- 
tion of  the  uterus.  The  catarrhal  discharge 
alternates  with  rheumatic  pains  in  various 
regions  of  the  body.  Suitable  for  fat,  light 
haired  persons  who  are  subject  to  catarrh  of 
all  the  mucous  membranes. 

Kali  ferrocyanatiim.  Purulent  catarrh,  profuse, 
not  irritating,  that  follows  the  menses. 
Usually  in  the  day  time  only.  Pain  in  the 
small  of  the  back.  Acidity  and  pressure  at 
the  stomach  after  eating.  Menses  too  fre- 
quent and  too  profuse. 

Kali  iodatum.  Catarrh  watery,  acrid,  corrosive 
with  biting  in  the  pudendum  ;  milky,  white, 
green  or  yellow,  putrid.  Discharge  that  re- 
sembles the  vv^ashings  of  meat.  Subinvolu- 
tion of  the  uterus.  Hypertrophy  and  en- 
largement of  the  uterus.  Uterine  fibroids. 
Constant  catarrh.  Pain  in  the  back — lum- 
bago. Hard  swelling  of  glands  and  infiltra- 
tion of  cellular  tissue  are  characteristic  of 
Kali  iodatum.  Syphilis  or  mercurialization 
will  always  be  considered. 

Kali  muriaticiLin.  Bland  milky  catarrh.  Thick, 
yellow,  slimy  discharge.  Kali  muriaticum 
will  rarely  be  indicated  in  genital  catarrh 
unless  there  is  a  concomitant  pelvic  exudate 
the  result  of  a  former  pelvic  cellulitis.  In 
this  condition  the  remedy  is  well  nigh  a  spe- 
cific. 


124  i,kucorrhce:a. 

Kali  phosphoricuin.  Catarrh  yellowish,  blister- 
ing, orange  colored,  scalding  and  acrid.  In- 
tense sexual  desire  after  the  menses.  Amen- 
orrhoea  with  depression  of  spirits,  lassitude 
and  general  nervous  debility.  Kali  phos. 
covers  the  entire  field  of  nervous  exhaustion. 

Kali  sulphuriciun.  Purulent  catarrh,  yellow, 
green.  The  vaginal  lymphatics  are  involved, 
and  there  is  desquamation  of  the  genital 
epithelium. 

Kalmia  latifolia.  Yellowish  catarrh  one  week 
after  menstruation,  at  which  time  all  the 
symptoms  are  aggravated.  This  remedy 
will  be  thought  of  when  there  are  severe 
pains  in  the  region  of  the  heart — angina  pec- 
toris. Rheumatic  pains  suddenly  leave  the 
extremities  ;  stitches  in  the  heart.  Hyper- 
trophy of  the  heart  and  valvular  insuffi- 
ciency.    Articular  rheumatism. 

Kreosotum.  Catarrh  putrid,  acrid,  corrosive,  that 
stains  the  linen  yellow,  and  stiffens  it  like 
starch.  White  discharge  having  the  odor  of 
green  corn.  A  bland  yellow  discharge  pre- 
cedes each  urination.  Drawing  pains  from 
the  coccyx,  extending  into  the  rectum  and 
vagina.  Electric  like  stitches  in  the  vagina. 
Itching  in  the  vagina.  Vaginal  mucous 
membrane  swollen,  burning  and  puffy. 
Brownish  acrid  catarrh,  offensive.  Sanguin- 
eous catarrh.  Erosion  of  the  cervix  with 
watery,    offensive   catarrh.     The   character- 


THKRAPi:uTlC   SUGGi:STlONS.  J 25 

istic  catarrh  of  Kreosotum  is  offensive  and 
excoriating. 

Lachesis.  Catarrh  from  three  to  eight  days  be- 
fore the  menses,  green  or  thick  yellow. 
Copious,  smarting,  stiffening  the  linen,  stain- 
ing it  green.  Simple  mucous  catarrh  with 
redness  and  swelling  of  the  pudenda.  Uterus 
enlarged,  os  open,  with  ectropion  of  the 
endometrium.  The  vaginal  mucosa  and  that 
covering  the  portio  vaginalis  are  dark  blue 
from  venous  stasis,  with  tendency  to  bleed 
when  touched.  Purpura  hemorrhagica. 
Especially  indicated  at  the  climacteric,  and 
for  affections  developing  after  that  period 
has  passed. 

Lactic  acid.  Catarrh  that  stains  the  linen  saf- 
fron yellow. 

Leptandra.  Catarrh  with  erosion  of  the  cervix, 
shreds  of  mucus.  Sometimes  fetid.  Irrita- 
tion of  the  bladder,  much  dull  aching  in  the 
abdomen. 

Lilimn  tigrimim.  Constant  mild  profuse  catarrh 
that  stains  the  linen  greenish  yellow.  Thin 
acrid  excoriating  discharge  leaving  a  brown 
stain  on  the  linen.  Bright  yellow  catarrh, 
excoriating  the  pudendum.  Bearing  down, 
and  distress  in  the  pelvic  region.  Must  hold 
herself  together.  Dry  mealy  spots  on  the 
labia,  with  intolerable  itching.  All  the  uter- 
ine ligaments  and  supports  are  relaxed. 
Offensive   catarrh   resembling   the   white  of 


12d  I^E^UCORRHC^A. 

egg,  with  dull  pain  in  the  ovaries.  Almost 
constant  bachache.  Chronic  ovaritis  and 
neuralgia  of  the  ovaries. 

Lycopodium.  Catarrh  milky,  bloody,  in  starts, 
corroding,  aggravated  before  a  full  moon. 
Catarrh  thin,  yellow,  ulcers  on  the  os  uteri. 
The  catarrh  alternates  with  dryness  of  the 
vagina.  There  is  an  entire  absence  of  the 
normal  secretion  of  genital  mucus.  The 
skin  is  unhealthy,  there  is  eczema  on  the 
genitals  that  bleeds  easily,  and  is  covered 
with  a  thick  offensive  secretion.  When 
Lycopodium  is  indicated  there  will  always 
be  found  excoriations  where  mucous  mem- 
brane and  skin  pass  into  each  other,  the 
anus,  the  vulva  and  the  mouth. 

Magnesium  carbonicnm.  Acrid,  white  mucous 
catarrh  preceded  by  colic.  Watery  catarrh 
after  the  menses,  thin,  scanty,  with  pinching 
around  the  navel.  All  the  pains  are  lancin- 
ating, and  lightning  like.  The  muscles  are 
lax  and  flabby.  Rheumatic  affections.  There 
is  a  sour  smell  from  the  entire  body. 

Magnesium  7nuriaticum.  Catarrh  watery,  or 
thick,  followed  immediately  by  a  discharge 
of  blood.  After  exercise,  with  every  stool, 
preceded  by  spasm  and  contraction  of  the 
uterus.  Uterine  spasm  followed  by  a  profuse 
discharge  of  mucus.  A  remedy  of  wide  use- 
fulness in  many  gynaecological  conditions. 

Magnesium  sulphuricum.  Catarrh  thick,  profuse, 
with  bruised  pains  in  the  small  of  the  back. 


THKRAPi:uTlC    SUGGE:STI0NS.  127 

Mercurins.  Muco-purulent  catarrh,  constant, 
but  ag-i^ravated  after  menstruation.  Catarrh 
containing  lumps,  sticky,  green,  bloody, 
causing  burning  and  intense  itching.  White 
patches  on  the  vaginal  and  labial  mucosa, 
which  when  removed  leave  a  raw  surface. 
Labia  swollen.  Spasms  of  the  vagina,  vul- 
vitis, erosion  and  ulceration  of  the  cervix. 
All  the  conditions  of  Mercurius  are  aggra- 
vated in  the  cold  air,  and  by  cold  water- 
There  is  also  an  aggravation  after  becoming 
warm  in  bed.  Suitable  for  light  haired  per- 
sons, with  lax  skin  and  muscles. 

Mercurins  corrosivus.  Profuse,  muco-purulent 
catarrh,  pale  yellow,  tinged  with  blood ;  thin 
mucous  discharge  causing  intense  burning 
and  heat.  Inflammation  of  the  vulva  and 
vagina.  The  symptoms  seem  to  be  in  excess 
of  the  local  pathology. 

Merc2irius  iodatus  flavus.  Copious  muco-puru- 
lent catarrh,  yellow  catarrh  particularly  in 
young  girls,  or  children.  The  entire  skin  is 
irritated,  causing  persistent  itching. 

Mezereiiin.  Catarrh  like  the  white  of  ^^^,  cor- 
roding. Mucous  discharge  from  the  vagina 
and  urethra.  Erosion  of  the  cervix.  Mucous 
catarrh  tinged  with  blood.  Smarting,  burn- 
ing, pricking  in  the  ulcerated  uterus.  Thick 
honey-comb  scabs  cover  all  the  eruptions, 
which  itch  intolerably  and  bleed  easily  when 
touched. 


128  LEUCORRHCEA. 

Murex  purpurea.  Watery,  greenish,  irritating 
catarrh,  with  dragging  and  relaxation  of  the 
perineum,  pain  in  the  hips,  loins  and  down 
the  thighs.  With  the  catarrhal  discharge 
the  mental  conditions  improve.  Uterus 
swollen  and  cervix  elongated.  Soreness  of 
the  cervix.  There  is  usually  disturbance  of 
the  sexual  function;  most  intense  sexual  ex- 
citement. 

Myrica  cerifera.  Excoriating,  fetid,  thick  and 
yellowish  catarrh.  Chronic  catarrh.  Urine 
high  colored,  saturated  with  the  coloring 
matter  of  bile. 

Naja  tripudians.  Thin,  white  catarrh  in  the 
afternoon.  Cramping  pain  in  the  left  ovary, 
ovarian  congestion. 

Natrum  carbonicum.  Profuse  genital  catarrh 
after  frequent  attacks  of  colic.  Frequent 
copious  urination.  Thick,  yellow,  putrid 
catarrh.  Bearing  down  as  if  the  uterus 
would  protrude.  Passive  congestion  of  the 
uterus.  Leuco-phlegmatic  constitution  with 
aversion  to  the  open  air,  and  disinclination 
to  exertion,  either  mental  or  physical. 

Natrum  viuriaticum.  Profuse,  acrid,  greenish 
catarrh  in  the  morning,  transparent,  watery, 
greenish,  particularl}^  after  walking,  with 
headache  ;  corrosive,  transparent  mucus, 
causing  excoriation,  irritation  and  itching, 
with  falling  off  of  hair  from  the  pubes.  Pim- 
ples on  the  mons  veneris. 


ThKRAPKUTIC    SUGGi:STlONS.  129 

Natrum  phosphoricum.  Creamy,  honey  colored 
catarrh.  Watery,  sometimes  acrid  catarrh. 
Prolapsus  uteri. 

Natrum  snip hiiri cum.  Acrid  corrosive  catarrh. 
Vulvitis  with  swelling.  Vulva  covered  with 
vesicles  the  size  of  lentils,  filled  with  pus. 
Prolapsus  uteri.  Purulent  catarrh  during 
pregnancy.  Phlegmasia  alba  dolens.  All  the 
conditions  are  brought  on  or  aggravated  in 
damp  weather. 

Niccolum.  Profuse  watery  catarrh,  especially 
after  urinating,  and  following  menstruation. 
Periodic  nervous  headaches,  recurring  every 
two  weeks.     Amenorrhoea. 

Nitric  acid.  Catarrh  of  ropy  mucus,  green 
mucus,  flesh  colored,  acrid,  brown,  offensive. 
A  sudden  gush  of  muddy  water  following 
violent  pain  in  the  abdomen.  Coffee  ground 
offensive  discharge  from  the  uterus  at  the 
climacteric,  or  after  labor.  Very  offensive 
urine.  Pain  in  the  small  of  the  back  with 
burning  pain  running  down  the  limbs.  Vag- 
initis with  cracks  and  ulcers  on  the  labia 
minora,  aggravated  by  cold  bathing.  Ero- 
sion of  the  cervix,  the  glandular  hyperplasia 
is  very  marked,  and  bleeds  easily  when 
touched.  Eczema  of  the  genitals.  Suitable 
for  persons  suffering  from  diarrhoea.  There 
is  rarely  constipation. 

Nux  moschata.  Genital  catarrh  in  the  place  of 
the  menses  in  women  who  always  awaken 

10 


130  LEUCORRHCEA. 

with  a  dry  tongue.  Functional  affections  of 
the  heart,  nervous  palpitation  of  the  heart. 
Flatulent  distension  of  the  abdomen,  when 
it  can  be  traced  to  some  nervous  disturbance. 
Clairvoyant  state  of  the  mind. 

N21X  vomica.  Catarrh  of  yellow  mucus,  fetid, 
staining  the  clothing  yellow.  Swelling  of 
the  vagina,  with  prolapsus  of  the  uterus. 
Corrosive  itching  eruption  of  the  vulva. 
Chronic  metritis,  hardness  and  swelling  of 
the  uterus.  Prolapsus  of  the  uterus  with 
bearing  down  pains.  A  great  variety  of 
pains  in  the  back.  Stiff  neck,  lumbago, 
spinal  irritation,  convulsive  spasm  and  twitch- 
ing of  single  muscles  brought  on  by  a  sud- 
den jar,  or  shock.  Excitable,  irritable  dis- 
position, inclined  to  sudden  anger.  Tense 
fibre,  irascible  temperament.  Constipation. 
Conditions  associated  with  overindulgence 
in  alcohol,  and  induced  by  rich  living. 

Oleum  animale.  Thin  white  mucous  catarrh. 
Choking  and  constriction  of  the  throat. 
Itching  like  flea  bites,  disappearing  suddenly, 
or  changing  to  burning  heat. 

Oleum  jecoris  aselli.  Purulent  uterine  catarrh. 
Pain  in  the  back,  lumbago.  Difficult  to 
walk  because  of  pain  in  the  sacro-iHac  syn- 
chondrosis.    Patients  are  always  cold. 

Origanum.  Profuse  mucous  catarrh  which  is 
only  a  concomitant  symptom,  depending 
upon    sexual   irritation,    and   uncontrollable 


THKRAPKUTIC    SUGGe:sTIONS.  131 

sexual  desire  which  leads  to  masturbation, 
and  the  effort  to  overcome  which  induces 
religious  insanity.  The  presence  of  men  ex- 
cites the  desire  to  masturbate,  rather  than 
for  sexual  intercourse.  Young-  girls,  divorced 
women,  widows,  old  maids,  with  the  most 
intense  sexual  excitement,  driving  almost  to 
despair.  Itching  of  the  vulva,  with  catarrh. 
An  invaluable  remedy  in  the  treatment  of 
masturbation  in  females. 

Palladium.  Yellow  catarrh  becoming  white  and 
thick.  Transparent  jelly  like  catarrh,  pre- 
ceding and  following  menstruation.  Affec- 
tions of  the  right  ovary.  Pain,  weight  and 
soreness  in  the  region  of  the  uterus  making 
walking  and  standing  almost  impossible. 
There  is  a  peculiar  sensation  of  being  very 
tall  when  walking. 

Petroleum.  Burning,  acrid,  profuse,  excoriating 
mucous  catarrh.  Itching  and  burning  in  the 
vagina  and  labia.  Pruritus  with  herpetic 
eruptions.  The  concomitant  skin  symptoms 
will  suggest  this  remedy.  The  skin  is  un- 
healthy, with  a  tendency  to  crack,  leaving 
moist  surfaces,  or  deep  fissures.  Itching, 
thick  scabs,  from  under  which  oozes  pus. 
The  discharges  are  usually  excoriating,  and 
aggravated  in  winter. 

PJiosphoric  acid.  Profuse,  yellow,  thin,  acrid 
mucous  catarrh,  after  the  menses.  Itching 
of  the  vulva.     Ulceration  of  the  cervix,  with 


132  LEUCORRHCKA. 

bloody  profuse  discharge.  Inflammation  of 
the  uterus.  Weakness,  neurasthenia.  Hys- 
teria in  young  girls.  Suppression  of  exan- 
themata by  cold. 

Phosphorus.  Milky,  excoriating  catarrh  during 
menses,  with  cold  hands  and  feet,  and  cut- 
ting in  the  left  ovarian  region.  In  the  place 
of  the  menses,  a  white,  watery  mucus;  acrid 
and  excoriating  catarrh,  causing  blisters  and 
soreness.  Slimy,  bloody  catarrh  in  old 
women.  Stitches  running  from  the  vagina 
into  the  pelvis.  CEdema  of  the  labia. 
Nymphomania.  Sterility  from  excessive  sex- 
ual feeling.  The  patient  is  very  susceptible 
to  external  impressions.  Amenorrhoea  with 
a  weeping  mood.  Suitable  to  tall,  slender 
blondes,  or  blondes  with  red  hair,  a  quick, 
lively  disposition,  and  sensitive  nature. 

Physostigma.  White  milky,  or  bloody,  scanty, 
stringy  catarrh,  aggravated  about  four  o'clock 
in  the  afternoon.  Dread  of  cold  water. 
Weakness  of  the  muscular  system. 

Phytolacca.  Thick,  tenacious  and  irritating  ca- 
tarrh in  women  who  suffer  from  various 
glandular  swellings,  and  from  abscesses  in 
the  breasts.  Uterine  catarrh,  nerosis  of  the 
cervix,  and  even  ulceration.  Aching  and 
soreness  all  over  the  body.  Rheumatic  dia- 
thesis. 

Platinum.  Catarrh  like  white  of  ^^%  after  rising 
from  sitting.     Excessive  sexual  desire  with 


thKrapi^utic  suggestions.         133 

over-sensitiveness  of  the  genitals,  inducing 
spasms  during  an  examination.  Premature 
development  of  the  sexual  instinct.  An  arro- 
gant over-estimation  of  one's  self,  and  one's 
importance,  with  haughtiness  towards  others. 
She  wishes  to  embrace  every  one  she  meets. 

Podophylhiin  peltatinn.  Thick,  transparent  mu- 
cous catarrh.  Bearing  down  pain  in  the 
small  of  the  back  during  menstruation,  pain 
in  both  ovaries,  numbness  and  aching  pain 
running  down  the  thighs.  Pain  in  the  right 
ovary  involving  the  anterior  crural  nerve. 

Prumis  spinosa.  Excoriating  catarrh  coloring 
the  linen  yellow.  Frequent  urgent  desire  to 
urinate,  which  if  not  attended  to  immedi- 
ately causes  very  sharp  pains  in  the  bladder. 

Psorimun.  Catarrh  in  large  lumps  that  have  an 
intolerable  odor.  Violent  cramps  in  the  sac- 
rum and  right  loin.  Induration  of  the  right 
ovary.  Moist  eczematous  eruptions.  All 
the  discharges  have  a  carrion  like  odor,  even 
the  perspiration  is  foul. 

Pulsatilla.  Catarrh  painless,  thick  mucus  hav- 
ing the  color  of  milk,  especially  on  lying 
down.  Catarrh  acrid,  thin,  with  pruritus, 
near  the  change  of  life,  or  before  menstrua- 
tion is  fairly  established.  Thick,  white 
mucus,  with  backache.  The  menses  are  too 
late,  or  are  suppressed;  menstrual  colic. 
Affections  from  getting  the  feet  wet.  Pro- 
lapsus   uteri.     The    patient    is   tearful   and 


134  I.KUCORRHCSA. 

easily  discouraged.  She  is  anxious.  Anxiety 
in  the  epigastric  region.  The  patient  is 
moreover  always  chilly,  but  finds  relief  in 
the  open  air.  The  pains  of  Pulsatilla  appear 
suddenly,  and  leave  gradually;  they  also 
shift  rapidly  from  part  to  part. 

Ranuncidtis  biilbosiis.  Catarrh  at  first  mild,  be- 
coming acrid  and  corroding.  Ovarian  neu- 
ralgia, chronic  cases  always  excited  by  at- 
mospheric changes.  Vesicular  eruptions,  as 
from  burns.  Shingles,  and  intercostal  neu- 
ralgia. Eruptions  of  blisters  secreting  a  foul 
smelling  gluey  matter. 

Robinia.  Yellow  green,  thick,  acrid  catarrh. 
Purulent  catarrh  with  tumefaction,  and 
bruised  feeling  in  the  cervix,  and  general 
prostration.  Ulcerative  pains  in  the  vagina, 
with  acrid  yellowish  catarrh  having  a  most 
fetid  odor.  Sensation  as  if  the  brain  re- 
volved; as  if  the  head  were  full  of  boiling 
water. 

Rjita  graveolejis.  Corrosive  catarrh  after  irregu- 
lar or  suppressed  menstruation.  Pressure  to 
urinate,  though  there  is  little  urine  in  the 
bladder.  If  the  urine  is  retained  it  cannot 
be  voided. 

Sabina.  Yellow,  ichorous,  fetid  catarrh,  and 
painful  discharge  of  fetid  blood  every  two 
weeks,  during  the  climacteric.  Catarrh  of  the 
consistence  of  starch,  copious,  milky,  caus- 
ing itching.     Ropy,  glairy  catarrh  from  the 


thKrape:utic  suggestions.         135 

cervical  canal,  with  drawing  pain  in  the  back 
through  to  the  pubes.  Corrosive  catarrh  in 
a  primipara  causing  soreness  and  itching  of 
the  thighs.  Stitches  from  below  upwards 
deep  in  the  vagina.  Protracted  uterine  haem- 
orrhage arising  from  loss  of  tone  in  the 
vessels  of  the  uterus,  blood  dark  and  clotted. 
There  is  a  tendency  to  abort  at  the  third 
month.  Threatened  abortion  with  profuse 
mucopurulent  catarrh. 

Sanguinaria  Canadensis.  Corrosive  fetid  catarrh 
at  the  climacteric.  Ulceration  of  the  uter- 
ine OS,  which  bleeds  readily. 

Sarracenia  purpurea.  Watery  or  milky  catarrh, 
thick,  whitish,  foul  smelling,  with  spasmodic 
pains  in  the  uterus.  Cervix  swollen  and  hot. 
Miliary  eruption  on  the  vulva;  heat  in  the 
vulva. 

Sarsaparilla.  Catarrh  that  continues  six  months 
after  parturition,  with  labor  like  pains  from 
the  sacrum  to  the  crest  of  the  ilium,  heat 
and  pulsation  in  the  sacrum.  White  catarrh 
when  walking  or  exercising,  severe  pain  at 
the  close  of  urination.  Eruptions  that  ap- 
pear in  the  spring  time.  Eruptions  of  vari- 
ous kinds  that  are  aggravated  on  passing 
from  a  warm  room  to  the  open  air. 

Secale  cornutum.  Green  brown,  offensive  catarrh 
in  thin,  scrawny  women.  Creamy  catarrh 
with  weakness  and  venous  congestion. 
Ulcers  on  the  pudendum  which  spread  rap- 


136  I^EUCORRHC^A. 

idly.     A  peculiar  feeling-   of   numbness  and 
formication   in    the    fingers  as  if  the}^  were 
asleep.     Prickling  in  the  fingers.     This  is  a 
marked  concomitant  symptom  of  Secale.     It 
is   characteristic    of   this   drug   that    all    the 
symptoms  are  aggravated  at  night,  by  touch 
and  from  external  warmth,  and  relieved  from 
cold.     The  skin  is  dry,  dingy,  and  wrinkled. 
Senecio.     Genital  catarrh  in  little  girls  preceded 
by  headache.     Sleeplessness;   irritable  blad- 
der, especially  at  night.     Amenorrhoea. 
Sepia.     Gelatinous  catarrh.     Sensation  as  if  the 
uterus  would  fall  out  of  the  vagina,  she  must 
cross  her  legs  to  prevent  it  from,  doing  so. 
The   cervix   is   swollen    and   dry,    and   does 
actually    protrude   from   between  the   labia. 
The  OS  uteri  is  wide  open  and  will  admit  the 
finger,    even    when    not    lacerated.     Yellow 
catarrh    most    profuse    before   the    menses. 
Acrid  catarrh  before  the  menses,  especially 
in  young  women.     Profuse  yellowish  green 
catarrh  in  the  place  of  the  menses.     Yellow- 
ish green  catarrh  excoriating,  with  heat  and 
pain  in  the  sacrum.     Menses  a  dirty  brown 
color.     Dryness  of  vulva  and  vagina,  causing 
a  very  disagreeable  sensation  of  friction  when 
walking.     The  vaginal   mucosa  is  a  reddish 
brown  color.     Catarrh  bloody,  slimy,  yellow- 
ish or  hke  milk,  especially  profuse  after  uri- 
nating.    Profuse,  lumpy,  fetid  mucus,   acrid, 
causing    soreness    of    the    pudendum.     Dis- 


the:rape:utic  sugge:stions.         137 

charge  as  clear  as  water.  Yellowish,  or 
greenish  watery  catarrh  during  pregnancy, 
and  at  the  climacteric.  Catarrhal  discharge 
coming  away  in  starts.  Thick,  yellow,  acrid 
catarrh  during  the  day  only,  with  constant 
pressure  in  the  sides  of  the  pelvis.  Very 
profuse  catarrh  in  children.  Severe  pruritus. 
Erosion  and  ulceration  of  the  cervix.  The 
cervix  is  greatly  indurated.  Offensive,  ex- 
coriating catarrh  during  pregnancy.  Pain  in 
the  sacrum  extending  through  the  hips  and 
thighs  to  below  the  knees.  Faintness,  nau- 
sea, exhaustion,  an  all  gone  feeling  in  the 
pit  of  the  stomach.  Constipation.  Herpetic 
eruptions.  Brown  spots  on  the  skin.  Sad, 
gloomy,  and  despondent.  Suited  to  persons 
with  dark  hair,  of  rigid  fibre,  but  of  a  mild, 
gentle  disposition. 
Silicea,  Acrid  catarrh  before  the  menses,  with 
sensation  of  swelling  of  the  vulva,  and  sore- 
ness of  the  perineum.  Watery  catarrh  in 
the  place  of  the  menses.  Profuse  yellow, 
excoriating,  tenacious  catarrh.  The  entire 
genital  mucosa  is  red,  vascular,  moist,  and 
exquisitely  sensitive,  rendering  sexual  inter- 
course impossible.  Chronic  headache  re- 
lieved by  warmth,  and  by  having  the  head 
wrapped.  Profuse  sour  perspiration  on  the 
head  in  the  evening.  Exhaustion  from  ere- 
thism. Want  of  vital  heat,  not  renewed  by 
exercise.     Strong  desire  to  be  magnetized. 


138  LEUCORRHd^A. 

Swelling  and  inflammation  of  glands. 
Chronic  suppuration.  Especially  suited  to 
youth  and  adolescents. 

Stillingia  sylvatica.  Copious  mucopurulent  ca- 
tarrh, with  rheumatic  pains,  chiefly  perios- 
teal.    Secondary  syphilis. 

Sulphur.  White  watery,  copious  catarrh,  com- 
ing in  gushes,  staining  the  linen  yellow.  The 
discharge  contains  yellow  granules  like 
crushed  mustard  seeds.  Chronic  catarrh 
causing  burning  and  smarting  of  the  vulva, 
and  thighs  (pathognomonic).  Pudenda  sore 
and  burning,  milky  catarrh.  Smarting  as 
from  salt,  aggravated  at  night.  The  patient 
must  bathe  with  warm  water,  cold  water 
aggravates  the  soreness,  and  smarting. 
Burning  in  the  vagina,  she  cannot  remain 
quiet,  must  constantly  shift  her  position. 
Yellow,  excoriating  catarrh  a  fortnight  be- 
fore menses.  Menstruation  is  too  early,  and 
lasts  too  long.  Hot  flashes  at  the  climac- 
teric. Bearing  down  pains,  congestion  of 
the  uterus.  The  Sulphur  patient  is  ver}^ 
sensitive  to  the  open  air,  and  will  not  be 
bathed;  she  takes  cold  easily.  Affections 
following  suppressed  eruptions.  There  is  an 
offensive  odor  from  the  skin,  despite  frequent 
bathing,  to  which  however  there  is  an  aver- 
sion. A  marked  tendency  to  congestion  of 
the  internal  organs.  Suppuration,  the  pus 
being  of  foul  odor.     Comedones,  frequently 


THERAPEUTIC    SUGGESTIONS.  139 

on  the  face.  Acne  punctata.  Adapted  to 
lean  persons  who  never  stand  straight,  or  sit 
up  straight.  Stoop  shouldered  young  girls. 
Peevish,  fretful  disposition. 

Sidphuric  acid.  Catarrh  acrid  and  burning, 
milky  or  transparent,  or  of  bloody  mucus. 
Appearing  at  the  climacteric,  with  hot 
flashes. 

Stunbtil.  Catarrh  of  white  mucus,  especially 
when  sitting,  with  hot  flashes  at  the  climac- 
teric. Nervous  palpitation  of  the  heart  in 
hysterical  subjects  at  the  change  of  life,  ag- 
gravated by  thinking  of  how  the  heart  is  act- 
ing. 

Syphilinuni.  Profuse,  thick  yellow  catarrh,  with 
flabbiness  of  the  vaginal  mucosa.  Soreness 
of  the  vulva  with  mucopurulent  catarrh  in 
children,  aggravated  at  night.  Acrid,  cans, 
ing  itching,  and  inflammation,  increased  from 
the  warmth  of  the  bed.  Uterine  and  ovarian 
diseases  with  profound  nervous  disorders, 
especially  in  married  women.  Affections 
of  the  left  ovary.  All  the  conditions  are 
aggravated  at  night,  and  many  from  the 
heat  of  the  bed. 

Tabacimi.  Simple  catarrh  following  menstrua- 
tion, or  during  the  change  of  life.  The 
patient  feels  cold,  and  has  a  sense  of  ex- 
cessive wretchedness.  This  latter  condition 
is  most  marked  under  Tabacum,  as  is  an 
almost  constant  sick  headache. 


140  i,Kucorrhce:a. 

Tarantula.  Sanguineous  catarrh,  with  constant 
desire  to  urinate.  Mucopurulent  catarrh  be- 
fore menstruation,  with  intense  sexual  ex- 
citement. Catarrh  causing  burning  and 
smarting,  with  painful  uneasiness  in  the 
cocc3^x.  Enlargement  of  the  cervix.  Chronic 
vaginitis  with  granulations  in  the  vagina, 
and  on  the  portia  vaginalis.  Hyperesthesia 
of  the  entire  nervous  system,  the  least  ex- 
citement irritates.  Hysteria  with  trembling 
of  the  body.  Cannot  remain  quiet,  she  is 
constantly  moving  the  hands  and  feet.  All 
the  nervous  symptoms  are  aggravated  by 
music,  which  was  formerly  enjoyed,  and 
most  agreeable  to  her.  Sexual  excitement, 
even  nymphomania,  induced  b}^  irritation  of 
the  terminal  nerves  of  the  genital  organs, 
rather  than  by  any  cerebral  disturbance. 

TerebintJiina.  Sanguineous,  offensive  catarrh 
with  fibroid  enlargement  of  the  uterus. 
Burning  in  the  uterus,  pains  at  the  crest  of 
the  ilium  aggravated  by  the  least  motion  or 
jar  in  walking  or  riding.  Neuralgia  in  the 
vagina.  Burning  that  extends  along  the 
large  nerve  trunks. 

Thuja.  Yellowish  catarrh  causing  smarting  of 
the  vagina  and  vulva.  Bland  mucous  catarrh 
from  one  menstrual  period  to  another,  which 
leaves  a  yellowish  green  stain  on  the  linen. 
Burning  and  smarting  in  the  vagina  when 
walking.      Congestion    of     the    left    ovary. 


THKRAPKUTIC   SUGGESTIONS.  141 

Squeezing  pain  in  the  ovary.  Erosion  of 
the  OS  uteri,  on  which  there  are  spots  Hke 
aphthae.  Uterine  polypus.  Warts  and  con- 
d3domata,  and  other  excrescences  about  the 
vulva;  these  are  flat  v/ithout  pedicles.  Seedy 
warts,  pedunculated,  oozing  moisture  which 
has  a  peculiar  coppery  odor.  Wandering 
rheumatic  pains  aggravated  by  warmth,  re- 
lieved by  cold. 

Trillitun  pendiihnn.  Profuse  yellow  and  thick 
catarrh  between  the  menstrual  periods. 
Sanguineous  catarrh  with  great  prostration. 
A  menorrhagic  history,  the  blood  being 
bright  red  and  coming  in  gushes,  is  an  essen- 
tial part  of  the  Trillium  gynaecological  pic- 
ture. 

Urtica  urens.  Acrid,  excoriating  catarrh,  with 
stinging  itching  and  oedema  of  the  vulva. 
Pricking  and  stinging  characterizes  this  rem- 
edy.    Urticaria. 

Ustilago.  Excoriating  albuminous  catarrh  be- 
fore menstruation,  which  is  too  early  and 
profuse,  the  flow  being  bright  red,  and  in 
gushes  when  rising  from  a  seat,  or  after  hav- 
ing been  startled,  or  frightened.  Or  at 
times  the  menstrual  flow  is  dark,  in  clots 
that  are  expelled  from  the  vagina  where 
they  form.  Neuralgia  of  the  ovaries.  Tall 
slim  women  with  fair  complexion. 

Viburnum  opulus.  Thin,  yellow  white  or  color- 
less catarrh  except  during  stool,  when  it  be- 


142  Iv^UCORRHCEA. 

comes  thick  yellow,  and  streaked  with  blood. 
Catarrh  for  two  days  following  menstruation, 
yellowish  white.  Dysmenorrhcea  with  draw- 
ing in  the  anterior  muscles  of  the  thighs. 
Pains  begin  in  the  back  going  around  the 
loins  to  the  anus  and  to  the  pubic  bones,  like 
labor.  Membranous  dysmenorrhcea.  Espe- 
cially indicated  for  tall  slender  women  who 
suffer  from  chronic  dysmenorrhcea,  spas- 
modic, or  membranous. 

Xanthoxylum.  Great  increase  of  the  catarrhal 
discharge  during  the  time  when  the  menses 
should  appear.  Dysmenorrhcea  with  agon- 
izing pains  driving  the  patient  almost  dis- 
tracted. Neuralgic  pain  following  the  course 
of  the  genito-crural  nerve.  Suitable  for 
women  of  spare  habit,  and  of  a  delicate 
nervous  temperament.  Pains  that  run  down 
the  thighs,  with  scanty  and  retarded  men- 
strual flow. 

Zincuni.  Thick  bloody  mucus  after  menstrua- 
tion, or  before  the  flow,  preceded  by  cutting 
colic,  causing  itching  of  the  vulva.  Thick 
mucous  catarrh,  especially  in  the  morning 
on  rising.  Thick  and  slimy  discharge  with 
sensitiveness  of  the  vagina  and  vulva.  Acrid 
and  excoriating  catarrh  in  the  place  of  the 
menses.  Pruritus  which  leads  to  masturba- 
tion, from  which  nymphomania  develops. 
Varicose  veins  of  the  pudendum.  Ulcera- 
tion  of   the   uterus;    there  is  a  bloody  dis- 


THE:rAPE:uTIC   SUGGi:STlONS.  143 

charge,  the  ulcerated  surface  being  without 
sensation.  Left  ovarian  neuralgia.  There 
is  great  lassitude,  especially  upon  waking  in 
the  morning,  even  after  a  good  night's  sleep. 
Cerebral  exhaustion.  Rhagades  mostly  be- 
tween the  fingers;  painful  cracking  of  the 
skin. 
Zizia.  Catarrh  bland  and  profuse,  commences 
on  the  second  day  after  menstruation  and 
continues  slight  in  quantity,  at  first  acrid, 
later  becoming  bland  and  copious.  Acrid 
catarrh  following  profuse  menstruation.  Sud- 
den suppression  of  the  menses,  or  they  may 
appear  at  the  regular  time  but  cease  after 
twelve  hours. 


REPERTORY. 
PART  II. 

VARIETIES  OF  CATARRH. 

Albuminous.     Ustilago,  Borax. 

Bloody.  Lycop.,  Merc,  Mez.,  Phos.,  Phos.  acid., 
Physos.,  Viburnum  (streaked  with), 
Sabina  (fetid),  Sepia,  Copaiva,  Coffea  c. 
(mucous),  Conium. 

Clots.     Curare. 

Creamy.     Secale,  Calc.  p.,  Natrum  p. 

Curdy.     Helonias. 

Egg,  like  the  white  of.  Am.  m..  Borax,  Bovista, 
Calc.  c,  Hydrastis,  Lilium  t.,  Mez.,  Plati- 
num. 

Gelatinous.     Sepia. 

Ichorous.     Sabina. 

Lumpy.  Sepia,  Ant.  c.  (of  mucous),  Aloe  (like 
jelly),  Calc.  c.  (of  pus),  Psorinum. 

Meat,  like  the  washings  of.     Cocculus,  Kali  jod. 

Milky.  Sarrac,  Phos.,  Puis.,  Sabina,  Sulph.  a., 
Nat.  p.,  Niccolum,  Kali  jod..  Kali  m., 
Angustura,  Calc.  c,  Ferrum,  Gelsemium, 
Conium,  Copaiva,  Carbo  v.,  Coffea  c. 

Mucous.     Caulophyllum,  Copavia,  Conium,  Euca- 
lyptus,   Act?ea    r.,    Agnus   c,   Aurum    m.. 
Nitric  a.,    Nux  v..   Puis.,   Oleum   a.,   Ori- 
ganum,   Sulphuric    a.   (bloody),    Sumbul, 
II 


146  i,e:ucorrh(Ka. 

Mucous — Continued. 

Thuja,      Tabacum,       Zincum      (bloody), 
Lachesis,  Mez.,  Phos.  a.,  Podophyllum. 

Muco-purulent.  ^Esculus  h.,  Alumen,  Bufones, 
Canth.,  Carboa.,  Cocculus,  Sabina,  Merc, 
Merc,  c,  Merc.  iod.  f.,  Stillingia,  Syphili- 
num,  Tarantula. 

Purulent.  Bufones,  Calc.  c,  Calc.  s.,  Copaiva, 
Curare,  Ham.,  Hepars.,  Hydrastis,  Igna- 
tia,  Kali  ferro.,  Robina. 

Slimy.  Amm.  m.,  Carbo  a.  (bloody),  Phos., 
Sepia. 

Sanguineous.  Arg.n.,  Ars.,  Baryta  c,  Calc.  s., 
Canth.,  Cocculus,  Ham.,  Kreosot.,  Taran- 
tula, Terebin.,  Trillium,  Ant.  t..  Aloe, 
Amm.  m. 

Shreds.     Canth.  (of  mucus),  Leptandra. 

Starchy.     Borax,  Sabina. 

Stringy.     Bovista,  Merc,  Hydrastis,  Kalib.,  Nit. 

Transparent.  Alumina,  Nat.  m..  Palladium,  Sulph. 
a.,  Podophyllum,  Stannum. 

Thick.     Mag.  m.,  Nat.  c 

Thin.  Anacardium,  Asafoetida,  Carbo  v.,  Lyco- 
pod..  Iodine,  Lilium  t.,  Naja  t.,  Oleum  a., 
Phos.  a..  Viburnum  op. 

Tough.     Hydrastis  (mucus). 

Tenacious.     Phytolacca,  Silicea,  Kali  b. 

Watery.  Amm.  c.  Ant.  c,  Hydrastis,  Kali  jod., 
Mag.  c,  Mag.  m.,  Murex  p.,  Nat.  p., 
Niccolum,  Sarracenia,  Silicea,  Cham., 
Helonias. 


r^pe:rtory.  147 

Water.     Sepia  (as  clear  as). 

THE   COLOR   OF   THE   DISCHARGE. 

Bluish  white.    Amb.  g. 

Brown.     Amm.  m.,  Kreosot.,  Nitric  a.,  Secale. 

Coffee  grounds.     Nitric  a. 

Dark.     Helonias. 

Green.  Apis,  Asaf.,  Bovista,  Carb.  a.,  Cubeba, 
Kali  jod,,  Kali  s.,  Lachesis,  Merc,  Murex 
p.,  Natr.  m,,  Nitric  a.,  Secale,  Graph. 

Honey,  the  color  of.     Natr.  p. 

White.  Ars.,  Aurum  m..  Borax,  Conium,  Kreos., 
Mag.  c,  Naja  t.,  Oleum  a..  Palladium, 
Physostigma,  Podophyllum,  Robinia,  Sar- 
rac,  Sarsap.,  Stannum,  Sulph.,  Sumbul, 
Syphilinum,  Viburnum. 

Water,  like  muddy.     Nitric  acid. 

Yellow.  iEsculus,  Ars.,  Alumina,  Angustura, 
Argent,  n.,  Asarum,  Aurum  m.,  Bovista, 
Carbo  v.,  Chamomilla,  Colocynth,  Con- 
ium, Cubeba,  Inula,  Iodine,  Kali  b.,  Kali 
jod.,  Kali  m..  Kali  s.,  Kalmia,  Lachesis, 
Lilium  t. ,  Lycopodium,  Merc,  c,  Merc. 
jod.  r.,  Myrica  c,  Natr.  c,  Nux  v..  Palla- 
dium, Phos.  a.,  Robinia,  Sabina,  Sepia, 
Silicea,  Stannum,  Sulphur,  Syphilinum, 
Thuja,  Trillium,  Viburnum. 

THE    NATURE   OF    DISCHARGE. 

Acrid.  Alumina,  Apis,  Amm.  c,  Ars.,  Ant.  c, 
Berberis,     Borax,  Calc.  c,  Caulophyllum, 


148  I^KUCORRHd^A. 

Acrid — Cofituiued. 

Cham.,  Chel.,  Conium,  Copaiva,  Cubeba, 
Eucalyptus,  Nat.  m..  Fluoric  acid.  Graph., 
Hydrastis,  Kali  jod.,  Kreosot.,  Lilium  t., 
Mag.  c,  Nat.  p.,  Puis.,  Nat.  s..  Nitric 
acid.,  Ranunculus,  Robinia,  Sepia,  Silicea, 
Zizia  (in  the  beginning),  Sulph.  a.,  Syphi- 
linum,  Urtica  u.,  Zincum. 

Bland.  Caulophyllum,  Zizia,  Cyclamen,  Kali 
ferro..  Kali  m.,  Kreosot.,  Lilium  tig.,  Pul- 
satilla, Ranunculus,  Thuja. 

Burning.    Carbo  a.,  Conium,  Sulph.  a..  Tarantula. 

Corrosive.  Alumina,  Arg.  n.,  Aurum  m.,  Carbo 
a.,  Carbo  v.,  Calc.  c,  Ferrum,  Ignatia, 
Iodine,  Kali  jod.,  Nat.  s..  Ranunculus, 
Ruta  g.,  Sabina,  Sang.,  Silicea. 

Excoriating.  Graph.,  Kreosot.,  Merc,  c,  Myrica 
c,  Phos.,  Psorinum,  Urtica  u.,  Ustilago, 
Zincum. 

Hot.     Hydrastis. 

Irritating.  Murex  p.,  Phytolacca,  Alumen,  Alu- 
mina. 

Scalding.     Sulphur. 

Smarting.  Ferrum,  Lachesis,  Lilium  t..  Sulphur 
(like  salt).  Tarantula. 

Water,  sensation  of  warm.     Borax. 

THE   MANNER   IN    WHICH   THE    DISCHARGE 
TAKES    PLACE. 

In  gushes.  Gelsemium,  Graph.,  Lycopod.,  Nitric 
acid  (sudden).  Sepia,  Sulphur. 


ri:pe:rtory.  149 

Fits  and  starts.     Calc.  c. 
Paroxysms.     Ant.  t. 
Intermitting.     Carbo  v. 

GENERAL   CONDITIONS    AND   CONCOMITANTS  OF 
THE    DISCHARGE. 

Abdomen,  dull  aching  in  the.     Leptandra,    Inula 

(sensation  of  moving  in  the). 
Angina  pectoris.     Kalmia. 
Abortion,  tendency  to.     Sabina. 
Air,  aversion  to  fresh.     Natrum  c. 

sensitive  to  fresh.     Hepars.,  Ant.  c. 
Back,  aching  in  lower  part  of  the.    Gelsem.,  Helo- 
nias. 
ache,    Aurum    m.,    Baryta   c,    Puis.,    Podo- 
phyllum. 
in  the  small  of.    Kali  ferro.,  Mag.  s.,  Nitric  a. 
lameness,     ^sculus,  Conium. 
lumbago.     Kali  jod.,  Nux  v.,  Oleum  jec. 
rheumatism  of  the.     Actsea  r. 
weakness  of  the.     Graphites. 
spinal  irritation.     Nux  v. 
drawing  fro'^n  the,  to  pubes.     Sabina. 
pain  begins  i7t  the,  extending  to  the  loins, 
anus  and  pubic  bones.     Viburnum. 
\^wit\^,  constipation.    ^Esculus,  Amm..  m.,  Alumen, 
Aloes,    CoUinsonia,     Cubeba,    Graphites, 
Nuv  v..  Sepia. 
Bladder,  irritable.     Canth.,    Erigeron,  Leptand., 
Senecio. 
sharp  pain  in  the.     Prunus. 


150  I^KUCORRHC^A. 

Blood,  bright  red.     Ustilago. 

dark  clots.     Sabina,  Ustilago. 

fluid.     Ant.  c. 
Bilious.     Cubeba,  CheL,  Berb. 
Broad  ligament,  spasmus  of  the.     Actaea  r. 
Bearing  down.     Lilium  t.,  Nat.  c,  Nux  v. 
Breasts,   swelling    of   the,    suppuration.     Phyto- 
lacca. 

tenderness  of  the.     Helonias. 
Breath,  loss  of,  on  going  up  stairs.     Iodine. 
Breathing,  difficult.     Stannum. 
Bathing,  aversion  to.     Sulphur. 
Brain,  sensation  as  if  revolving.     Robinia. 
Colic.     Natrum  c,  Colocynth.,  Mag.  c. 
Coccyodinia.     Fluoric  a. 
Coccyx,  pain  from,  into  the  rectum  and  the  vagina. 

Kreosote. 
Coitus,  impossible  because  of  sensitiveness  of  the 

vagijia.     Silicea. 
Coldness  of  extremities.     Ferrum. 
Chilliness,  relieved  in  the  open  air.     Pulsatilla. 
Chilliness.     Cyclamen. 

Cold,  takes  easily.     Am.  c,  Sulph.,  Oleum  jec. 
Cough,  alternates  with  catarrh.     Iodine. 

spasmodic.     Cyclamen. 
Convulsions.     Caulophyllum. 
Congestion,  active.     Erigeron,  Gelsemium. 
Debility.     Hydrastis,  Calc.  c,  Carb.  v. 
Emaciation.    Arsenicum. 
Epilepsy.     Cedron. 
Exertion,  aversion  to  making  any.    Natr.  c. ,  Ant.  t. 


ri:pi:rtory.  151 

Exhaustion,  cerebral.     Zincum. 
Face,  comedones  on  the.     Sulphur. 

acne.     Sulphur. 

red.     Gelsemium,  Ferrum. 

pale.     Helonias,  Ars. 

salloiv.     Helonias. 
Fall,  bad  effects  of.     Conium. 
Faint,  tendency  to.     Cyclamen. 
Feet,  cold.     Phos. 
Fingers,  pricking  in  the.     Secale. 

numbness  of  the  tips  of  the.     Stannum. 

cracks  between  the.     Zincum. 
Groin,  strained  feeling  in  the.     Amm.  m. 

dragging  in  the.     Ferrum. 
Glands,  swelling  of  the.     Kali  jod.,  Silicea,  Phyto- 
lacca. 
Head,  constant  sick  headache.    Tabacum,  Natr,  m. 

occipital  ache,     ^sculus,  Cocculus,  Gelsem- 
ium,  Silicea. 

ache  every  two  weeks.     Niccotin. 

sour  perspiration  on  the.     Silicea. 

pressure  on  the.     Asarum. 

ache^  nervotis.     Arg.  n. 

as  if  it  were  ftill  of  boiling  water.     Robinia. 
Heart,  valvular  diseases  of  the.     Kalmia. 

palpitation     of     the.       Sumbul,     Nux      m., 
Baryta  c. 

hypertrophy  of  the.     Kalmia. 

functional  affections  of  the.     Nux  m. 

pain  in  the.     Kalmia. 
Hands,  constant  movements  of  the.     Tarantula. 

cold.     Phos. 


152  i,i:ucorrhce:a. 

Hyperesthesia  of  the  entire  nervous  system.     Taran- 
tula, Cocculus. 
Hysteria.     Phos.    a.,   Gelsemium,    Asaf.,  Sumbul, 

Tarantula. 
Haemorrhage,  tende7icy  to.     Erigeron. 
Lassitude.     Zincum,  Carbo  v. 
Languor.     Helonias. 
Lymphatics  swollen.     Bromine. 
Lips  blue.     Carbo  a. 
Labia,  pudenda,  aphthce  of  the.     Carbo  v. 

biting  like  salt.     Canth.,  Kali  jod.,  Sulph. 

burnijig.     Ars. 

cracks.     Nitric  a. 

cervix y  protruding  from  the.     Sepia. 

excoriations.     Lycopodium. 

eczema  on  the.     Lycopodium. 

itching.     Origanum. 

heat  in  the.     Helonias. 

mealy  spots  on  the,  with  itching.     Lilium  t. 

neuralgia  of  the.     Apis. 

oedema  of  the.     Apis,  Phos. 

patches y  white,  on  the.     Merc. 

pulsation  in  the.     Calc.  p. 

rawness  of  the.     Carbo  v. 

red  spots  on  the.     Carbo  v.,  Helonias. 

soreness   of  the.     Sepia,    Sulphur,    Bovista, 
Carbo  v. 

swollen.     Amm.    m.,    Colocynth.,    Helonias, 
Lachesis,  Merc. 

swelling  of  the  7'ight.     Apis. 

ulcers  on  the.     Secale. 


re:pe:rtory.  153 

Labia —  Co7i  thi  ued. 

varices  on  the.     Calc.  c,  Zincum. 

voluptuous  itching  of  the.    Calc.  p.,  Coffea  c. 
Love,  disappointed  in.     Calc.  p. 
Mental  states  and  symptoms. 

Arrogant.     Platinum. 

Changeable  mood.     Asaf.,  Ignatia. 

Clairvoyant.     Nux  m. 

Mental  symptoms  improve  with  the  increase 
of  the  catarrh.     Murex  p. 

Depressed.     Amm.  m.,  Agnus  c,  Sepia. 

Despondent.     Sepia. 

Dullness.     Agnus  c. 

Grief y  suppressed.     Ignatia. 

Homesick.     Ignatia. 

Insanity   caused  by  effort  to  control  intense 
sexual  desire.     Origanum. 

Irritable.     Bovista,  Cham.,  Ignatia,  Nux  v., 
Tarantula. 

Irascible.     Nux  v. 

Listless.     Amm.  c. 

Melancholia.     Ignatia. 

Mesmerized^  strong  desire  to  be.     Silicea. 

Peevish,  fretful.     Sulphur. 

Suffering,  intolerant  of.     Cham. 

Weeping  mood.     Phos.,  Puis. 
Masturbation,  induced  by  itching  of  the  genitals. 

Zincum,  Origanum. 
Menstruation,   catarrh   in   the   place  of.     Graph., 
Nux    V,,    Silicea,    Sepia,     Zincum,    Ars., 
Cedron,  Cocculus,  Cubeba,  Ferrum. 


154  I,i:UCORRHCHA. 

Menstruation — Coiitinued. 

before.     Zincum,   Borax,  Cedron,  Bovista, 
Silicea. 

after.     Agnus    c,    Tabacum,    Viburnum, 
Zizia,  Bovista,  Graphites. 
early.     Calc.  c,  Calc.  p.,  Sulph. 
delayed.     Graphites,     Calc.     s..     Cyclamen, 

Puis. 
checked.     Ant.    c,    Zizia,     Niccolum,     Puis., 

Phos. 
profuse.     Helonias,  Kali  ferr.,  Iodine,  Secale, 

Ustilago,  Trillium,  Zizia,  Ferrum,  Sabina. 

at  night.     Amm.  m. 
only  at  nigJit,  in  bed.     Cyclamen. 
ceases  when  rising  frorn  bed.     Cyclamen. 
during  the  day  only.     Causticum. 
burning  and  itching  before.     Calc.  c. 
eruptions  precede.     Dulcamara. 
painful  {dysmenorrhcea) .      Viburnum,   Xan- 

thoxylum,  Caulophyllum,  Collinsonia,  Puis. 
in  gushes.     Ustilago. 
epilepsy  dtiring.     Cedron. 
Mons  veneris,  blisters  on  the.     Phos. 

eruptions,  sero-purulent  on  the.     Conium. 
hair,  falling  off  of  the.     Natr.  m. 
itching  of  the.     Natr.  m. 
pimples  on  the.     Natr.  m. 
Muscles,  iveakness  of  the.     Ferrum,  Physos. 
twitching  of  the.     Nux  v. 
lax.     Mag.  c. 
Nervous,  excitable.     Gelsemium. 

depressed.     Leptandra,  Xanthoxylum. 


ri:pe:rtory.  155 

Neuralgia.     Gelsemium,  Terebinthina. 
genito-cmral.     Xanthoxylum. 
anterior  crural.     Podophyllum. 
Neurasthenia.     Phos.,  Kali  p. 

Odor  of  the  catarrh,  offensive.     Ars.,  Asaf.,  Bovista, 
Garb,   a.,  Colocynth,  Cubeba,  Carbolic  a., 
Eucalyptus,    Kali  jod.,   Graph.,   Helonias, 
Leptandra,     Lilium     t.,     Kreosot.,    Lye, 
Nitric     a.,     Psorinum,     Robinia,    Sabina, 
Sanguinaria,      Sarrac,      Sepia,      Secale, 
Terebinth. 
sour.     Curare. 
of  old  cheese.     Hepar  s. 
as  of  the  menses.     Causticum. 
froin  the  body^  offensive.     Hepar  s.,  Sulph. 
sour.     Mag.  c. 
Ovaries,  pressure  and  burning  in  the.     Canth. 
throbbing  in  the.     Copaiva. 
dull  pain  in  the.     Lilium  t.,  Podophyllum. 
congestion  of  the.     Naja  t.,  Thuja. 
neuralgia  of  the.     Ranunculus,    Lilium   t., 

Ustilago,  Apis. 
ovaritis,  chronic.     Lil'ium  t. 
left.     Syphilinum,     Thuja,     Ustilago,    Naja, 

Phos.,  Psorinum,  Alumen,  Bromium. 
right.     Apis,  Palladium,  Podophyllum. 
Perineum,   dragging  in  the,   relaxed.     Murex  p., 

Silicea  (soreness). 
Purpura  hemorrhagica.     Lachesis. 
Pelvic  cellulitis.     Kali  m. 
Pelvis,  pressure  in  the.     Sepia. 


156  I.i:UCORRHCHA. 

Pains  appearing  suddenly^  disappearing  gradually. 
Puis. 

increase  and  decrease  gradually.     Stannum. 

bearing      dozvn.       Ferrum,      Caulophyllum, 
Sepia. 

flying.     iEsculus. 

spasmodic.     Erigeron. 

lancinating.     Mag.  c. 

labor  like.     Ignatia. 

lightning  like.     Mag.  c. 

as  of  a  knife.     Gelsemium. 

change  locatioji,  suddenly.     Puis. 

squeeziiig.     Thuja. 

when  sitting  as  if  somethi?ig  were  being 
thrust  up  into  the  vagina.  Ferrum  jod. 
Pruritus.  Alumen,  Amb.  g.,  Anacard.,  Angust., 
Kali  b.,  Calc.  c,  Puis.,  Sepia,  Ignatia, 
Petrol.,  Collinsonia,  Cubeba,  Helonias, 
H3^drastis. 
Prostration.     Carboa.,  Trillium,  Robinia. 

develops  rapidly.     Calc.  c. 
Phlegmasia  alba  dolens.     Natr.  s. 
Rheumatism.     Stillingia,  Phytolacca,  Kalmia  (shift- 
ing). 

alternating  with  catarrh.     Kali  b. 

articular.      Kalmia. 
Sacrum,  heaviness  in  the.     Aloe. 

lameness  iii  the.     ^Esculus. 

weakness  in  the.     Graphites. 

cramps  in  the.     Psorinum. 

heat  i7i  the.     Sarsap. ,  Sepia. 


re:pe:rtory.  157 

Sacrum — Continued, 

pulsation  in  the.     Sarsap. 

pains  from  the,  extending  to  the  hips  and 

thighs.     Sepia. 
labor  like  pain  from  the,  to  iliu7n.     Sarsap. 
sacro  iliac  joint.     Oleum  j. 
Sexual  symptoms  and  conditions.     Congestion.    Amm. 

m.,  Fluoric  a. 
exciteme7it.     Agnus  c,    Amm.    m.,   Calc.  p., 

Coffea  c. 

intense.     Murex  p.,  Origanum,  Tarantula. 
development  premature.     Platinum. 
desire  excessive.     Origanum,  Platinum. 
irritation  of  organs.     Canth. 
nymphomania.      Amb.     g.,    iVnt.     c,    Phos., 

Tarantula. 
sensitiveness  of  the  organs.     Canth.,   Plati- 
num. 
ca^ises  spasm  during  examination.     Platina. 
Skin,  bleeds  easily.     Lycopodium,  Mez. 
crackifig  of  the,     Zincum. 
eczema  on  the  genitals.     Nitric  a. 
itching  like  flea  bites.     Oleum  a. 
crusts  on  the.     Graph.,  Mez. 
fssures  of  the.     Petroleum. 
eczematous  eruptions  on  the,  having  the  odor 

of  car ri 071.     Psorinum. 
vesicular  eruptions  on  the.     Ranunculus. 
shingles.     Ranunculus. 
eruptions  i^i  the  spring.     Sarsap. 
djy,  zurinkled.     Secale. 


158  i,e:ucorrhc^a. 

Skin —  Con  tin  tied. 

blisters.     Ranunculus. 

moist  eruptions  on  the.     Graphites,  Bovista. 

herpes.     Dulcamara,  Sepia. 

varicose  veins.     Fluoric  acid. 

erythema  {thighs).     Cubeba. 

warts,  having  a  coppery  odor.     Thuja. 

surfaces,  irritation  of  the.     Canth. 

capillaries  near  the  stirface  of  the.     Caust. 

plethora,   venous.     Carbo   a.,    Secale,    Ham. 

exanthemata,     suppression     of,    front    cold. 
Phos.  a. 

stinging  of  the.     Urtica  u. 

lax  a7id hanging.     Merc,  Bar3'ta  c. 
Stains  of  the  clothing  caused  by  the  discharge,  green- 
Bovista,  Lilium  t.,  Thuja. 

browit.     Lilium  t. 

yellow.     Agnus  c,  Carbo  a.,   Kreosot.,   Nux 
v.,  Prunus,  Sulphur. 

saffron.     Lactic  acid. 

corrodes  the  listen.     Iodine. 

stiffens  the  linen.    Kreosote,  Lachesis,  Kali  b. 
Suppuration.     Sulphur,  Silicea. 
Scarlet  fever,  sequelce  of.     Bromine. 
Sterility.     Amm.  m.,  Phos. 
Spasms.     Nux  v. 

Stomach,  gone  feeling  in  the.     Sepia. 
Sleeplessness.     Senecio. 
Trembling  of  the  body.     Tarantula. 
Thighs,  pain  in  the.     Murex  p.,  Podoph3dlum. 

pain  r uniting  down  the.     Xanthoxylum. 

drawing  in  the.     Viburnum. 


rKpKrtory.  159 

Tongue,  azvakens  ivitJi  a  dry.  Nux  m. 
Throat,  constriction  of  the.  Oleum  a. 
Uterus,  enlarged.     Lachesis,  Murex  p.,  Carbo  a., 

Carbo  a.,  Iodine,  Kali  jod. 
subinvoliited.     Actaea  r.,   Kali  b.,   Kali  jod., 

Nux  V. 
metritis,    chronic.     Ant.    t.,    Eupator.    pur., 

Amm.  m.,  Merc,  Phos.  a. 
indurated.      Amm.     m.,     Iodine,     Nux    v., 

Conium. 
retrojiexed.     ^sculus. 
retroverted.     Caulophyllum. 
prolapsed.     Alumina,     Angustura,     Arg.     n., 

Amm.  m.,  Ferrum  jod.,  Helonias,  Natr.  p., 

Nux  v..  Puis. 
misplaced.     Conium,  Helonias. 
pain  in  the.     Cedron,   Bufones,    Inula,  Gel- 

semium  (cramps),  Sarrac,  Terebinth. 
burning  in  the.     Calc.  c. ,  Terebinth. 
tenderness  of  the.     Nux  v.,  Palladium. 
fullness,  sensation  of.     Gelsemium. 
fibroids.     Kali  jod..  Terebinth. 
congestion   of  the.       Nat.    s.,    Sulph.,    Caul- 
ophyllum. 
uterosacral  ligaments  relaxed.     Lilium  t. 
polypus  of  the.     Thuja. 
sensatioji  as  if  the,  zvould  fall  out.     Sepia. 
Uterine  cervix,  portia  vaginalis,  os  uteri,  aphthcB  on 

the.     Thuja. 
erosions.     Alumen,  Arg.   n.,  Asaf.,  Carbo  a. 

Conium,   Helonias,   Fluoric  a.,    Hepar  s.. 


160  i,e:ucorrhce:a. 

Uterine  cervix — Contimted. 

Hydrastis,     Kreosote,    Leptandra,    Merc, 
Mez.,  Nitric  a.,  Phytolacca,  Sepia,  Thuja. 

ulceration  of  the.  Arg.  n.,  Bufones,  Hepar 
s.,  Hydrastis,  Phytolacca,  Merc.,  Sepia, 
Phos.  a.,Sangmnaria,  Lycopodium,  Iodine. 

granulations  on  the.  Arg.  n.,  Nitric  a. 
(bleeding  easily). 

hardness^  induration  of  the.  Carbolic  a., 
Hydrastis,  Iodine,  Sepia,  Conium,  Graph- 
ites. 

swelling  of  the.  Iodine,  Murex  p.,  Sarrac, 
p..  Sepia,  Canth.,  Graphites. 

elongated  (^cervix).     Murex  p. 

engorged.     Tarantula,  Lachesis  (dark  blue). 

ectropio7i  of  the  mucosa  of  the.     Lachesis. 

burning  ifi  the.     Bufones. 

bruised  feeling  in  the.     Robinia 

darting  pains  in  the.     Fluoric  a. 

dryness  of  the.     Sepia. 
Urethral  caruncle.     Coffea  c.  Eucalyptus. 
Urine,  saturated  with  bile.     Myrica. 

biting  like  salt.     Causticum. 

frequent.  Nat.  c,  Psorinum,  Eupatorium 
pur. 

cofistajtt  desire  to  urinate.     Tarantula. 

painful.     Aloe,  Canth.,  Copaiva. 

pain  at  the  close  of  urinating.     Sarsaparilla. 

pressure  though  little  urine  is  in  tJie  bladder. 
Ruta  g. 

if  retai^ied  cannot  be  voided,     Ruta  g. 


RI^Pi^RTORY.  161 

Urine —  Con  tin  tied, 

oily  iridescerit  film  on  the.     Alum  en. 
having  the  odor  of  violets.     Inula,  Eucalyp- 
tus g. 
Vagina,   aphthcE  of  the.      Borax,    Caulophyllum, 

Helonias. 
burning  in  the.     Ars.,  Amm.  m.,  Cham. 
ecchyniotic  patches  on  the.     Arg.  n. 
engorgement  of  the.     Iodine. 
epithelium^  desquamation  of  the.     Kali  s. 
dryness  of  the,     Lycopodium,  Sepia. 
granulations  on  the.     Alumen,  Tarantula. 
heat  of  the,     Colocynth,  Ham.  (relaxed). 
itching  of  the.       Kreosot.,    Merc,    Sabina, 

Syphilinum,  Ant.  t.,  Berberis,  Ferrumjod., 

Fluoric  a. 
lymphatics  of  the ^  swollen.    Kali  s.,  Bromine, 

Graphites. 
inflammatio7i  of  the.     Merc,  c,  Syphilinum. 
mucosa,  of  the^,  swollen.     Alumen,  Kreosot., 

Ferrum  jod.,  Nux  v..  Graphites. 

puffy.     Kreosot. 

dark  red.     Lachesis,  Silicea. 

absence  of  mucus.     Lycopodium. 

vascular.     Silicea. 

reddish  brown.     Sepia. 

raw  and  sore.     Ham.,    Berberis,    Anacar- 
dium.  Bromine. 
sensitive.     Alumen,    Silicea,  Zincum,   Ham. 
smarting  of  the.     Ant.  c.  Graphites,  Cham., 

Conium,  Thuja,  Xanthoxylum. 
spasms  of  the,     Merc. 

12 


162  IvEUCORRHC^A. 

Vagina —  Con  tin  ued. 

stitches  in  the,  from  below  upwards.   Kreosot. 

neuralgia  of  the.     Terebinthina. 

walking,  uncomfortable  diyiiess  iii  the,  whe7t. 
Sepia. 
Vaginismus.     Canth.,  Ignatia. 

Vaginitis.     Amm.    m.,    Berberis,    Cubeba,    Ham., 
Nitric  a.,  Tarantula. 

white  patches  witJi.     Merc.  c. 
Vulva,  aching,  throbbiiig  in  the.     Calc.  c. 

burning.     Ars.,  Aurum  m.,  Sulph. 

condylomata  on  the.     Thuja. 

dryness  of  the.     Sepia. 

eruptio7i,  itcJiing.     Nux  v. 

excoriation  of  the.     Amm.  c. 

heat  of  the.     Sarrac. 

herpes  on  the.     Petroleum,  Dulcamara. 

itching  of  the.  Calc.  c,  Carbo  v.,  Causti- 
cum,  Ferrum,  Ferrum  jod.,  Phos.  a., 
Sabina,  Urtica  u.,  Zincum. 

inflam^nation  of  the.     Merc. 

fniliary  eruption  on  the.     Sarrac. 

prurigo.     Carbo  v. 

oedema  of  the.     Apis,  Urtica  u. 

pricking  in  the.     Mez. 

soreness  of  the.     Syphilinum. 

sensitiveness  of  the.     Coffea  c. 

smarting  of  the.  Sulphur,  Thuja,  Causti- 
cum,  Ferrum. 

swelling  of  the.  Calc.  c,  Canth.,  Cedron, 
Natr.  s.,  Silicea. 


REJPE^RTORY.  163 

Vulva —  Continued. 

stitches  in  the.     Conium. 

ulceration  of  the.     Amm.  c. 

vesicles  07i  the.     Natr.  s. ,  Graphites. 

varices  on  the.     Carbo  v. 

warts  on  the.     Thuja. 
Weakness.     Caulophyllum,  Stannum. 
y^z.itr,  dread  of  cold.     Phos.,  Sulphur. 

AGGRAVATIONS. 

Atmospheric  changes,  air,  in  the  cold.     Merc. 

Afternoon.     Naja  t. 

Bathing,  cold.     Nitric  a.,  Sulphur. 

^t^j  from  the  warmth  of  the.     Syphilinum,  Merc. 

Bending.     Cocculus. 

Confinement,  after.    Asarum. 

Day,  during  the.     Kali  ferr.,  Sepia. 

four  P.  M.     Physos. ,  Lycopod. 
Eating,  after.     Cham.,  Kali  ferr.  (acidity  after). 
East  wind.     Hepar  s. 
Exertion,   exercise.     Helonias,    Physos.,    Sarsap., 

Calc.  c. 
Evening.     Zincum. 

Food,  overindulgence  in  rich.     Nux  v. 
Full  moon.     Lycopodium. 
Fright.     Ustilago. 

Feet,  getting,  wet.     Graphites,  Phos. 
Jar,  sudden.     Nux  v.,  Terebinth. 
Lifting,  when.     Helonias. 
Lying  down.     Pulsatilla. 
Labor,  after.     Nitric  a.,  Sarsap. 


164  i,eucorrhce:a. 

Menstruation,  before.     Baryta  c. ,  Carbo  v. ,  Ferrum, 

Sulph.,  Tarantula,  Palladium,  Sepia,  La- 

chesis,  Hydrastis. 
between.     Anacard.,  Colocynth.,  Trillium. 
after.     Hydrastis,  Kali  f err.,  Kalmia,  Merc, 

Niccolum,    Palladium,    Sepia,    Phos.    a., 

Carbo  v.,  Carbo  a. 
during.     Iodine. 
following  suppressed.     Ruta  g. 
Morning.     Amm.  m.,  Natr.  m.,  Zincum,  Graphites 

(on  waking). 
Night.     Secale,  Sulph.,  Caust.,  Syphilinum. 
Noise,  causes  trembling.     Cocculus. 
Music.     Tarantula. 
Men,    presence   of,    causes   desire   to    masturbate. 

Origanum. 
Pregnancy,  during.     Nat.  s.,  Sepia. 
Primipara.     Sabina. 
Riding.     Terebinth. 
Squatting  position.     Cocculus. 
Spring,  in  the.     Sarsap. 
Shock,  causes  twitching.     Nux  v. 
Sitting.     Sumbul,  Ant.  t.,  Platinum. 
Strain,  ill  effect  of.     Conium. 
Standing.     Carbo  a. 
Thinking  of  complaints.     Sumbul. 
Touch.     Secale,  Hepar  s. 
Urinating.     Apis,    Amm.    m..    Sepia,    Tarantula, 

Niccolum. 
before.     Kreosote. 
Uterus,  from  pressure  on  the.     Copaiva. 


re:pe:rtory.  165 

Walking.     Nat.    m.,    Sarsap.,    Tarantula,   Thuja, 

Natr.  m. 
Warm  room,  going  from,  into  open  air.     Sarsap. 
Warmth.     Secale,  Thuja. 

Weather,  damp.     Hepar  s.,  Natr.  s.,  Dulc.  (cold). 
Water,  cold.     Merc,  Sulphur. 
Winter.     Petroleum. 

AMELIORATIONS. 

Bathing  with  warm  water.     Sulphur. 

Cold,  froin.     Thuja,  Secale. 

Catarrhal  discharge,  all  the  conditions,  by.     Borax, 

Murex  p. 
Warmth,  (^headache').     Silicea. 
Wrapping  head.     Silicea. 

STAGES   OF  LIFE,   CONSTITUTION,   DISPOSITION, 
TEMPERAMENT. 

Anaemia.      Ars.,    Cyclamen,    Ferrum,    Amb.    g., 

Calc.  c. 
Blondes.     Phos.,  Mer.   c,  Kali  b.   (fat),  Ustilago, 

Bromine. 
Climacteric.     Aloe,     Baryta    c, .  Helonias,    Puis., 

Sabina,  Lachesis,  Nitric  a..  Sang.,  Sepia, 

Sulph.,  Sulph.  a.,  Sumbul,  Tabacum. 
Jiot  flashes   at   the.      Sulphur,    a.,    Sumbul, 

Sulphur. 
Catarrh,  subject  to.     Kali  b. 
Children.     Curare,    Merc.    jod.    r.,    Sepia,    Syphi- 

linum,  Caulophyllum.     Old.  Argentum  n. 
Dark  hair.     Sepia. 


166  L^UCORRHCE^A. 

Diathesis,  kce^norrhagic.     Amm.  m.,  Lachesis. 

rJieumatic.     Phytolacca. 
Diarrhoea,  subject  to.     Nitric  a. 
Dwarfish  women.     Baryta  c. 
Emaciation,  gradual.     Iodine. 
Enervated  from  luxury.     Helonias. 
Excitable.     Cedron,  Cham. 
Feeble  women.     Helonias. 
Girls.     Caulophyllum. 

{little^.     Calc.    p.,  Ignatia,  Phos.    a.,  Merc, 
jod.  r.,  Origanum,  Senecio,  Silicea. 
Hair,  red.     Phos.,  Sepia  (dark). 
Infants.     Cann.  s. 

Leucophlegmatic.     Nat.  c,  Cyclamen. 
Lean  persons,  who  never  stand  straight.     Sulphur. 
Married  women.     Syphilinum. 
Mild  gentle  disposition.     Sepia. 
Mothers,  j'^^^;?^^.     Asarum  {^plethoric). 
Nature,  sensitive.     Phos. 
Old  maids.     Gelsemium. 

women.     Aloe,  Ars.,    Baryta  c,    Carbo     v., 
Carbo  a.,  Conium,  Helonias,  Phos. 

for  tJieir  age.     Argent,  n. 
Obesity.     Graphites,  Amm.  c. 
Small,  delicate  women.     Erigeron. 
Scrofulous.     Bromine,  Iodine. 
Students.     Gelsemium. 
Syphilis.     Kali  jod. 
Stoopshouldered  girls.     Sulphur. 
Thin,  scrawny  women.     Secale. 
Tall,  slender.     Viburnum. 

pale.     Ustilago,  Helonias. 


RKPE^RTORY.  167 

Tired,  always.     Baryta  c. 

Young  women.     Amb.    g.,  Ars.,  Carbo  a.,  Sepia, 

Silicea. 
Voluptuous  nature.     Cedron. 
Widows.     Origanum. 


INDEX. 


A. 

Abrasions,  a  cause  of  catarrh  22 

Acetic  acid  and  alcohol  in  the  use  of  the  preparation 

for   trachelorrhaphy    89 

Acetic  acid  and  carbolic  acid    83 

Acid  reaction  of  simple  genital  catarrh  29 

the   normal   vaginal   secretion    14 

Acidity,  absence  of,   favorable  to  the  development  of 

micro-organisms     ^ 29 

Adenoma,  senile,  and  erosion  of  the  os  uteri  48 

Adolescence,  the  normal  vaginal  discharge  of   46 

Alkaline  reaction  of  normal  uterine  secretion   14 

Alumina,  the  use  of,  for  constipation    6^ 

Argyrol,  swabbing  out  the  uterus  with   100 

Arteries,  involvement  of  the  walls  of  the,  in  genital 

catarrh    20 

B. 

Bacillus,   the   vaginal    15 

Backache,   and  muco-purulent   catarrh    56 

Balsam  of   Peru  tampon    86 

Bartholin,   the   glands    of    29,  73 

Basement  membrane,  of  the  mucosa   3 

Baths,  the  medicated   99 

Baths,  preparation  of,  for  house  use   100 

Bicarbonate  of  soda   douche    39 

Blood,  significance  of,  in  genital  catarrh   55 

Birth,  the  genital  canal  at  10 

glandular   structures   at    32 

Boroglyceride,   the   use   of    59>  86 


I/O  INDEX. 

G. 

Calomel,  the  use  of,  as  a  dusting  powder  84 

Calyciform  cells,  the  character  of 9,  10,  13,   18,  28 

Carbolic  acid  douche  41,  58,  60,  83 

application  of,  to  the  cervix    59 

Cascara,  the  use  of,  for  the  constipation  of  children.  .     42 

Cascara   and  maltine    63 

Catarrh,   acute  genital    28 

in    children    3i>  43 

chronic  genital    28,  32 

classification    of    97 

constitutional  symptoms  of   56 

curettement  for  the  treatment  of 62 

gynaecological    14,    18,    42 

infection,  the  source  of   32 

the  local  causes  of  20 

muco-purulent    , 44,  47,  49,  50,  54,  55 

constitutional  treatment  of  . .     62 

local    treatment    of    57 

reaction   of    56 

symptoms    pf    56 

purulent    27,  62,  72,  76 

blood   in    y6 

clinical    course    of    79 

the   color  of    76 

source  of  injection  of   75 

origin  of   78 

senile    96 

treatment,    constitutional     .  .     93 

local      80 

sanguineous    28,   94,   96,  97 

the  treatment  of,   in  adults       99 
the  treatment  of  senile   .  .96,  loi 

simple   18,   27,  28,   32,  36 

treatment  of  general    41 

of  the  uterus   45 


INDEX.  171 

Catarrh  of  young  girls  21 

Cautery,  the  actual,  treatment  of  pruritus  with  102 

Cells,  breed  true    6 

calyciform 9>  ^o 

chalice    13 

goblet    9,    10,  14 

protoplasm    of    18,  28 

their  methods  of  discharging  mucus 14 

immature,  and  genital  catarrh  23 

Cervical  canal,  alkaline  reaction  of  the   8 

dilatation   of   the    89 

endometrium     of     the,     in     muco-puru- 

lent    catarrh    49 

the  lining  of  the   8 

Cervix,  erosion  of  the 48*  75 

treatment  of,    with   Iodine    ....     64 

Children,   catarrh   in    28,  30 

treatment    43 

constipation    in     42 

the  method  of  using  the  vaginal  douche  for    35 
Churchill's  tincture  of  Iodine,  the  action  and  use  of    60 

Cicatricial    tissue   after   operations    102 

Constipation  in  adults   42 

children    42 

*       and  gynecic  diseases    63,  64 

the  treatment  of   42 

Constitution  and  vicious  metabolism    23 

the  relation  of,  to  mucous  secretion    ....     21 

Corium,  a  layer  of  mucous  membrane   3 

glands  of  the,  at  birth    10 

Corpus  uteri,  the  lining  of  the  29 

secretion   of   the    9 

Creolin,  the  use  of,  for  douching 81 

Curettage    62,  87,   88,  89,  100 

after    treatment    of    93 

Curette,  the  use  of  the 89 


172  INDEX. 


D. 


Diathesis,  scrofulous  and  genital  catarrh    23,  43 

Discharge,  the  suspicious  character  of  a  bloody  99 

Douche,    bag   and   tip    38 

the   intra-uterine    87 

Alum  and  Sulphate  of  Copper   59 

Bichloride  of  Mercury   41 

Bicarbonate    of    Soda     39,  58 

Boracid  Acid   32,  41,  99 

Carbolic  Acid   41,   58,  60,  83 

Glycerite    of    Tannin    38 

Hydrastis    81,    99,  loi 

Iodine   58,  60,  81,  99 

Lead    Acetate    2>7 

Permang.  of  Potassa  99 

Sulphate  of  Copper  and  Alum   39 

method  of  giving  a    37 

to    children    35 

the    temperature    of   a    39 

Dusting  powders,  objection  to  the  use  of  84 

E. 

Ectropion  of  cervical  mucosa 49 

Eczema,    ointment    for     33 

Endo-cervicitis    51 

Endo-metritis,    atrophic     97 

hyperplastic    100 

and  purulent  catarrh    75,  79 

sanguineous    catarrh     95 

Epithelial  cells,  chalice    13 

calyciform    9,  10 

cylindrical     19 

of  genital  canal    12 

goblet    9,    10,  14 


INDEX.  173 

Erosion  of  the  cervix  48,  51 

Exanthemata,   suppressed    43 

Exanthematous  diseases,  and  genital  catarrh   29 

of  children    29 

F. 

Failure,  the  causes  of,   after  curettage  and  trachelor- 
rhaphy      88 

Fallopian  tubes,   catarrh   of  the    'j'j 

epithelium,    of    the    12 

glands  of  the  12 

in  purulent  catarrh   yz 

reaction  of  the  secretion  of  the   ....  16 

tuberculosis  of  the    78 

Fluors   alba    36 

Ferguson's    speculum    83 

G. 

Genital  canal,  development  of  the 2 

lining    of   the    i 

mucosa  of  the  2 

shape   of   the    7 

Gestation,  arrest  of,  a  cause  of  leucorrhoea  52 

appearance  of  mucosa   during   9 

changes  in  mucosa  during   10 

Glands,   of   Bartholin    29,  73 

genital,  development  of  the,  in  reproductive  life  45 

distribution    of    4 

of  mucous  membrane    4 

utricular    in    health    11 

Glandular    hyperplasia    61,    62,83 

Glycerine,  the  use  of,   in  vaginitis    4^ 

Glycerite  of  Iodine  61 

starch 34 

Goblet  cells,    18,   28,  39 

formation  of   13 

protoplasm   of    18 

secretion  of   8 


174  INDEX. 

Gonococci  in  the  vulva  i6 

Gonorrhoea!  infection  in  purulent  catarrh  74 

Granules    in    vaginal    mucous    membrane    in    purulent 

catarrh     74 

Gynaecological   catarrh,   complications    of    25,  27 

composition  of    26 

H. 

Headache,  a  symptom  of  muco-purulent  catarrh   ....  57 
Hot  Springs,  a  course  at,  in  the  treatment  of  genital 

catarrh     lOO 

Hydrastis,   fluid   extract,    douche    81 

tampon  86 

Hygiene,    necessity    for   regulating    65 

sexual    67 

Hymen,  epithelial   covering  of  the    7 

imperforate    34 

I. 

Ichthyol   vaginal   tampon    62,  86 

Infection,  avenue  of  pelvic   88 

conditions    favorable    for    17 

leucorrhoea    a    mixed    41 

immunity   from    22 

Iodine,  bactericidal  action  of  61 

Churchill's  tincture 60 

douche,  vaginal   58,  60,  81,  99 

douche,    intra-uterine    87 

and    Glycerine    61 

tampon     86 

the  use  of,  after  curettage  90,  100 

the  treatment  of  glandular  hyperplasia  with  61,  80 

L. 

Laceration  of  uterine  cervix,  causes  of  vicious  healing  92 

congenital     i  52 


INDEX.  175 

Laceration    of    the     uterine    cervix,    preparation     for 

operating    on    the    .  .80,  83 

in  purulent  catarrh    .  .75,  78 

stellate    91 

Lead  acetate  douche  37 

Leucorrhoea 36 

a   mixed   infection    41 

Lochia,  vaginal  bacilli  normally  absent  from  the 15 

Love,  effects  of  disappointed 43 

Lymphoid   elements    and  tissues    6 

M. 

Malignant  growths,  line  of  demarcation  of   49 

Masturbation,   a   cause   of    30 

Measles,  a  cause  of  genital  catarrh   24,  29 

Menopause,  and  sanguineous   catarrh    97 

Menstruation,  changes  in  epithelial  cells  that  attend  . .  45 
the    establishment    of,    and   sanguineous 

catarrh    98 

genital    glands    during    10 

Mercurius  dulcis,  the  use  of,  for  constipation   63 

Metabolism,  and  genital  catarrh    23 

Microbes,  the  cause  of  catarrh   20 

Micro-organisms    of    purulent    catarrh    45 

determine     the     differences    between 

forms  of  catarrh   96 

Mt.  Clemens,  the  baths  of   100 

Mucous  membranes,  the  blood  supply  of  4 

construction   of    3 

epithelial  covering  of   6 

essential   elements  of    13 

parts    of    S 

the  formation  of  genital 12,  16 

the  glands  of  34 

granules  developed  in  the  74 

the  treatment  of  congested 41 

the   office   of    3 


176  INDEX. 

Mucus,  cells  concerned  in  the  elaboration  of 3,  13 

the   method   of  being   discharged    from   goblet 

cells     '14 

Alullerian  ducts,  the  development  of  the   2 

N. 

Needles,  those  used  in  trachelorrhaphy 91 

Nervous    exhaustion    41 

Neurasthenia     70,  99 

Nitrate  of  Silver,  application  of,  to  the  uterine  cervix  83 

'                       the    treatment    of   pruritus    with    .  .  102 

Normal    salt    solution    88 

Nutrition,  errors  in,  a  cause  of  genital  catarrh   22 

O. 

Ointments,   the   method  of   applying    33 

the  use  of,  for  genital  eczema   33 

for  corrosive  catarrh   40 

Operation  for  pruritus    102 

Ovaducts,  physiological  current  of  the   79 

Ovaries,  diseases  of  the,  and  catarrh  24 

P. 

Pad,    the    vulvar    40 

Parturition,  the  relation  of,   to  muco-purulent  catarrh  51 

Pelvic  organs,  congestion  of  the,  in  constipation    ....  42 

Pelvis,  condition  of  the,  in  sanguineous  catarrh 99 

Peritoneum,  infection  of  the   79 

Phosphate  of  Soda,  the  use  of,   for  constipation    .  .42,  63 

Portio  vaginalis,   the    8 

the  coverings   of  the    8 

and    genital    catarrh    46 

purulent    catarrh    74 

the  secretions  of  the    8 

Potassium  permang.   douche    35 

Puberty,  development  of  glands  at  5,  10 


INDEX.  177 

Puerperium,  the  relation  of,  to  purulent  catarrh    ....  74 

Purulent    catarrh     ^2 

the   color  of    76 

in  old  women 'j^i 

Pruritus     81 

an    operation    for    102 

the  treatment  of  82,  102 

in    young    girls    50 

Pus  cells,  relation  of,  to  the  portio  vaginalis   47 

Pyogenic  cocci,  and  acid  media    15 

and  purulent  catarrh    79 

R. 

Reproductive  life,  the  changes  that  belong  to 45»  46 

S. 

Salines,  the  use  of,  for  constipation   42,  63 

Sarcoma,  diagnosis  from  sanguineous  catarrh   97 

Scarlet  fever,  a  cause  of  genital  catarrh 24,  29 

Scrofulous    diathesis     43 

and  catarrh  in  young  girls    ....  23 

Sebaceous   glands,   the   distribution   of    7 

Secretion,   alkaline,   of   the   uterus    8 

Secretions,   internal,   generators   of   disease    20 

Senile    colpitis     95 

endo-metritis   and   purulent  catarrh    "76 

and  sanguineous   catarrh,   95,   98,  loi 

Senility,  the  condition  of  the  uterus  in  96 

Sexual  excitement,  the  treatment  of   43 

hygiene  36,  (i^ 

Sigmoid  colon,  the,  and  constipation   42 

Skin,  the  condition  of,  in  muco-purulent  catarrh    ....  57 

Speculum,    Cusco's    58 

Ferguson's     83 

Spray,  method  of  using  the  vaginal  58 

Staphylococci  in  the  vulva  16 

13 


178  INDEX. 

Streptococci  in  the  vulva   16 

Students,   neurasthenia   in    44 

Sutures,    those    used    in    trachelorrhaphy    92,   93 

T. 

Tampon,  the  vaginal    59 

medicated    61,   62,  86 

method   of   making    84 

Tannin,  Glycerite  of,  douche  Z7 

Tenacious  genital  catarrh   39 

Tension,  surgical,  necessity  of  avoiding,   in  trachelor- 
rhaphy      92 

Thuja,  the  use  of,  for  douching   82 

Tissue  remedies,  the  use  of,  in  g3'nsecological  diseases  6) 

Trachelorrhaphy    87,    89,  90 

after   treatment    of    99 

Tubercle  bacilli  in  the  vulva   16 

Tuberculosis  of  the  Fallopian  tubes   78 

a  cause  of  purulent  catarrh   79 

U. 

Urethra,  the  lining  of  the   7 

Uro-genital   system,   development  of  the    2 

Uterine  diseases  and  genital  catarrh   24 

glands,  time  of  appearance  of,  in  corpus   ....       9 
OS,  erosion  of,  and  muco-purulent  catarrh   . .     47 

mucus    plug    in    the    15,    49 

secretion,  alkaline,  reaction  of  the  n,  45 

Uterus,  catarrh  of  the  45 

an    erectile   organ    67 

displacements  of  the,   in   simple  catarrh    .  .    36,  44 

epithelial  lining  of  corpus    9 

involution  of  the,   and   muco-purulent  catarrh     51 

irrigation    of    the    87 

lower  segment  of  the,  before  puberty   2>^ 

mucous   membrane  of  the    11 

retroflexion  of  the   52,  97 


INDEX.  179 

Uterus,    secretion   of  the,   normally    free   from   micro- 
organisms       16 

subinvolution  of  the,  and  genital  catarrh   36 

Utricular  glands  in  health  and  disease   II 

V. 

Vagina,  acid  secretion  of  the  7,  14,  22 

congestion  of  the,  in  muco-purulent  catarrh  45,  46 

catarrh  of  the 2J,  36 

lining   of   the    7 

mucous  glands  of  the    7 

a   self-cleansing  canal    53 

Vaginal    bacillus    15 

mucosa   in  purulent   catarrh    73 

walls  in  senile  purulent  catarrh    72 

Vaginitis,    and    muco-purulent    catarrh    45,    46 

simple    catarrh     29 

Virgins,   erosion   of  the  cervix   in    52 

laceration  of  the  cervix  in    52 

Volsella,  the  authors  for  trachelorrhaphy   91 

Vulva,   in  the  catarrh  of  children    30 

micro-organisms  found  in  the   16 

condition  of  the,   in,   muco-purulent  catarrh...     47 

Vulvitis  and  purulent   catarrh    y2> 

simple   catarrh,    the   treatment   of    ...,40,   41 

W. 

White   sulphur   springs,   for   the   treatment   of  genital 

catarrh    100 

Witch  Hazel  and  Hydrastis  douche   81 

Y. 

Young  girls,  genital  catarrh  of  21 

sanguineous  catarrh  of   98 

Z. 

Zinc    chloride    douche    loi 

stearate  dusting  powder   40 


mm'ssfm^M^-si^wm-»M 


.^> 


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